BLACKHAWK MANGUM, LLC


Address: 118 South Louis Tittle, Mangum, OK 73554
Phone: 5807822113

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QP2300X Clinic/Center
Specialization: Primary Care
2208 OK Ambulatory Health Care Facilities

Other Provider/Organization Names

Other Name Type Code
Quartz Mountain Medical Clinic - Mangum Doing Business As Name - Organization

Other Provider IDs and Locations

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

Office Location

Street Address 118 SOUTH LOUIS TITTLE
City MANGUM
State OK
Zip Code 73554

Providers in the same zip code

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 Information

Taxonomy Code 261QP2300X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Primary Care

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1609476654 Team Clinic Management Partners LLC Clinic/Center 372 N Cobb, Caney, OK 74533 2020-10-29
1184222705 Essential Md, Pllc Clinic/Center 6316 E 102nd St Ste 100, Tulsa, OK 74137-7061 2020-10-15
1881292191 Team Clinic Management Partners LLC Clinic/Center 3100 W New Orleans St, Broken Arrow, OK 74011-1468 2020-10-09
1972115392 Team Clinic Management Partners LLC Clinic/Center 225 E Omaha St, Broken Arrow, OK 74012-1761 2020-08-18
1093327413 Team Clinic Management Partners LLC Clinic/Center 301 W New Orleans St, Broken Arrow, OK 74011-2206 2020-08-18
1962013110 Team Clinic Management Partners LLC Clinic/Center 4300 E Gary Street, Broken Arrow, OK 74014 2020-08-12
1750992038 Team Clinic Management Partners LLC Clinic/Center 251 E Omaha St, Broken Arrow, OK 74012-1761 2020-08-11
1689285975 Team Clinic Management Partners LLC Clinic/Center 301 E Tucson St, Broken Arrow, OK 74011-7235 2020-08-11
1417568700 Team Clinic Management Partners LLC Clinic/Center 1351 E Albany St, Broken Arrow, OK 74012-8995 2020-08-11
1164033569 Team Clinic Management Partners LLC Clinic/Center 6800 E Quincy Pl, Broken Arrow, OK 74014-4523 2020-08-11
Find all providers with the same taxonomy

Competitor

Search similar providers

City MANGUM
Zip Code 73554

Improve Information

Please comment or provide details below to improve the information on BLACKHAWK MANGUM, LLC.

Dataset Information

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.

Trending Searches