Blackhawk Mangum LLC
Clinic/Center, Rural Health in Mangum, OK. Organization (NPI-2).
NPI number1295069151
StatusActive
Last updated in NPPESSep 25, 2009
Details
- NPI
- 1295069151
- Entity type
- Organization (NPI-2)
- Legal business name
- Blackhawk Mangum LLC
- Organization subpart
- No
- Enumeration date
- Sep 25, 2009
- Last updated
- Sep 25, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR1300X | Clinic/Center, Rural Health | – | – | Yes |
Other names
- Quartz Mountain Medical Clinic Mangum (Doing Business As)
Practice location
118 S Louis Tittle AveMangum, OK 73554-4441
Phone 580-782-3353
Mailing address
Po Box 280Mangum, OK 73554-0280
Phone 580-782-3353
Authorized official
Jan Winter
Ceo
5807823353
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