BLACKHAWK MANGUM, LLC (NPI# 1033388509) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1033388509 |
Entity Type | Organization |
Organization Name | BLACKHAWK MANGUM, LLC |
Other Organization Name | QUARTZ MOUNTAIN MEDICAL CLINIC - MANGUM |
Practice Address |
118 South Louis Tittle Mangum OK 73554 |
Mailing Address |
Po Box 280 Mangum OK 73554-0280 |
Practice Telephone | 5807822113 |
Practice Fax Number | 5807822141 |
Enumeration Date | 2008-02-28 |
Last Update Date | 2009-03-04 |
Authorized Official Name | SHANA DAVENPORT (INSURANCE CREDENTIALING SUPERVISOR) |
Authorized Official Telephone | 5126813460 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
2208 | OK | Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
Quartz Mountain Medical Clinic - Mangum | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1366611824 | Blackhawk Mangum, LLC | Clinic/Center | 513 East Chestnut, Hollis, OK 73550 | 2008-02-28 |
1093247082 | Blackhawk Mangum, LLC | Clinic/Center | 1 Wickersham St, Mangum, OK 73554-9117 | 2017-03-30 |
1811351703 | Blackhawk Mangum, LLC | Clinic/Center | 1 Wickersham St, Mangum, OK 73554-9117 | 2016-04-07 |
1316326770 | Blackhawk Mangum, LLC | Clinic/Center | 1 Wickersham St, Mangum, OK 73554-9117 | 2015-05-19 |
1760890040 | Blackhawk Mangum, LLC | Clinic/Center | 1601 Watts St, Sayre, OK 73662-1314 | 2014-07-30 |
1093986937 | Blackhawk Mangum, LLC | Emergency Medicine | One Wickersham Dr, Mangum, OK 73554 | 2008-03-19 |
1922147305 | Blackhawk Mangum, LLC | General Acute Care Hospital | 417 North Main St, Granite, OK 73547 | 2007-02-05 |
Street Address |
118 SOUTH LOUIS TITTLE |
City | MANGUM |
State | OK |
Zip Code | 73554 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1750845145 | Traci L Carrier | Licensed Practical Nurse | 115 S Lincoln St., Mangum, OK 73554 | 2019-01-30 |
1194295741 | Ez Sleep Solutions, Inc. | Dentist | 230 E. Jefferson, Mangum, OK 73554 | 2018-11-27 |
1881122976 | Lexie Noel Turner | Case Manager/Care Coordinator | 115 E Lincoln, Mangum, OK 73554 | 2017-06-01 |
1740640648 | Yco Tulsa, Inc. | Clinic/Center | 2100 North Louis Tittle, Suites 122-124 and 147-148, Mangum, OK 73554 | 2016-03-04 |
1750748984 | Teryl Pearson | Counselor | 2 Wickersham Dr., New Hope Recovery Center, Mangum, OK 73554 | 2016-01-19 |
1437525532 | Kiley Reneah Bachelder | Case Manager/Care Coordinator | 2 Wichersham Drive, Mangum, OK 73554 | 2015-08-12 |
1376941732 | Dana Juarez | Marriage & Family Therapist | 2100 N Louis Tittle, Mangum, OK 73554 | 2014-12-16 |
1104008168 | Blackhawk Mangum LLC | Medicare Defined Swing Bed Unit | One Wickersham Drive, Mangum, OK 73554 | 2007-12-03 |
1336356500 | Patrecia Ann Fite | Nurse Practitioner | 2100 North Louis Tittle Ave, Box 1, Mangum, OK 73554 | 2007-05-17 |
1164501433 | Bradley Paul Banister | Pharmacist | 1000 S. Louis Tittle, Mangum, OK 73554 | 2006-11-06 |
Find all providers in zip 73554 |
Taxonomy Code | 261QP2300X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Primary Care |
Definition to come... |
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1164033569 | Team Clinic Management Partners LLC | Clinic/Center | 6800 E Quincy Pl, Broken Arrow, OK 74014-4523 | 2020-08-11 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.