Blackhawk Mangum LLC
Organization Active NPI Clinic/Center · Altus, OK
NPI 1679966709 · NPPES record last updated Nov 17, 2015
Key facts
- NPI
- 1679966709
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- BLACKHAWK MANGUM LLC
- Practice address
- 3000 N Main St
Altus, OK 73521-1348 - Phone
- (580) 782-3353
- NPI assigned
- Mar 13, 2015
- Organization subpart
- No
Authorized official
- Name
- Kevin J Owens
- Title
- Owner
- Phone
- (580) 782-3353
National Provider Directory
Locations
3000 N Main St
Altus, OK 73521
Phone (580) 379-9770
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
3000 N Main St
Altus, OK 73521-1348
Mailing address
1 Wickersham St
Mangum, OK 73554-9117
Phone (580) 782-3353
Other names
- Quartz Mountain Medical Center Altus Clinic
Other providers in Altus, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.