NPIMap

Organization Active NPI

Blackhawk Mangum, LLC

Doing business as Quartz Mountain Medical Center - Hollis

  • Primary Care Clinic/Center
  • Hollis, OK
National Provider Identifier
1366611824
Registry record updated Jul 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
2208 Issued in OK
Legal business name
BLACKHAWK MANGUM, LLC
Doing business as
Quartz Mountain Medical Center - Hollis
Practice address
513 East Chestnut
Hollis, OK 73550
Phone
(580) 688-3314
Fax
(580) 688-9530
NPI assigned
Feb 28, 2008
Last updated
Jul 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shana Davenport
Title
Insurance Credentialing Supervisor
Phone
(512) 681-3460

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 2208 OK Primary

Addresses

Primary practice location

513 East Chestnut
Hollis, OK 73550

Mailing address

PO Box 280
Mangum, OK 73554-0280

Other names 1

  • Quartz Mountain Medical Center - Hollis Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Blackhawk Mangum LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216771200000",
    "number": "1366611824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280",
            "city": "MANGUM",
            "state": "OK",
            "postal_code": "735540280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 EAST CHESTNUT",
            "city": "HOLLIS",
            "state": "OK",
            "postal_code": "73550",
            "telephone_number": "580-688-3314",
            "fax_number": "580-688-9530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKHAWK MANGUM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-28",
        "last_updated": "2008-07-23",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "SHANA",
        "authorized_official_title_or_position": "INSURANCE CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "512-681-3460"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OK",
            "license": "2208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quartz Mountain Medical Center - Hollis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollis, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.