NPIMap

Organization Active NPI

Blackhawk Mangum, LLC

  • Critical Access Hospital
  • Granite, OK
National Provider Identifier
1922147305
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
2208 Issued in OK
Legal business name
BLACKHAWK MANGUM, LLC
Practice address
417 North Main St
Granite, OK 73547
Phone
(580) 535-4615
Fax
(580) 535-4466
NPI assigned
Feb 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mr. Brian Roland
Title
Cfo
Phone
(580) 782-3353

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 2208 OK Primary

Addresses

Primary practice location

417 North Main St
Granite, OK 73547

Mailing address

One Wickersham Drive
Mangum, OK 73554
Phone (580) 782-3353

Other names 1

  • MCH GRANITE FAMILY CLINIC Other name

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": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1922147305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE WICKERSHAM DRIVE",
            "city": "MANGUM",
            "state": "OK",
            "postal_code": "73554",
            "telephone_number": "580-782-3353",
            "fax_number": "580-782-5944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 NORTH MAIN ST",
            "city": "GRANITE",
            "state": "OK",
            "postal_code": "73547",
            "telephone_number": "580-535-4615",
            "fax_number": "580-535-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKHAWK MANGUM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "ROLAND",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "580-782-3353",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "OK",
            "license": "2208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MCH GRANITE FAMILY CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Granite, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.