BLACKHAWK MANGUM, LLC (NPI# 1366611824) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366611824 |
| Entity Type | Organization |
| Organization Name | BLACKHAWK MANGUM, LLC |
| Other Organization Name | QUARTZ MOUNTAIN MEDICAL CENTER - HOLLIS |
| Practice Address |
513 East Chestnut Hollis OK 73550 |
| Mailing Address |
Po Box 280 Mangum OK 73554-0280 |
| Practice Telephone | 5806883314 |
| Practice Fax Number | 5806889530 |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2008-07-23 |
| 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 Center - Hollis | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033388509 | Blackhawk Mangum, LLC | Clinic/Center | 118 South Louis Tittle, Mangum, OK 73554 | 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 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oklahoma Business Registrations | BLACKHAWK MANGUM, LLC | 1 Wickersham Dr, Mangum, OK 73554 |
| Street Address |
513 EAST CHESTNUT |
| City | HOLLIS |
| State | OK |
| Zip Code | 73550 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689121147 | Amy Michelle Ashcraft | Nurse Practitioner | 920 N 8th, Hollis, OK 73550 | 2016-09-01 |
| 1114391315 | Kimberly Yvette Hestand | Nurse Practitioner | 400 E Sycamore St, Hollis, OK 73550 | 2015-11-25 |
| 1619081189 | William Paul Estes | Dentist | 400 E Sycamore St, Hollis, OK 73550-1436 | 2006-08-19 |
| 1134744469 | Justin Cade Cole | Pharmacist | 400 E Sycamore St, Hollis, OK 73550-1436 | 2020-06-12 |
| 1710316476 | Leeann Boyles Stanford | Nurse Practitioner | 400 E Sycamore St, Hollis, OK 73550-1436 | 2013-11-04 |
| 1639415581 | Lacy Elizabeth Moon | Counselor | 400 E Sycamore St, Hollis, OK 73550-1436 | 2012-12-21 |
| 1255695201 | Shortgrass Community Health Center, Inc | Clinic/Center | 400 E Sycamore St, Hollis, OK 73550-1436 | 2012-06-25 |
| 1366654147 | Harmon County Healthcare Authority | Nursing Facility/Intermediate Care Facility | 400 E Sycamore St, Hollis, OK 73550-1436 | 2007-05-04 |
| 1831319334 | Bridget A Moss | Nurse Practitioner | 400 E Sycamore St, Hollis, OK 73550-1436 | 2007-04-26 |
| 1104961325 | Vickie June Godwin | Marriage & Family Therapist | 400 E Sycamore St, Hollis, OK 73550-1436 | 2007-02-21 |
| Find all providers in zip 73550 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| 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 |
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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.