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Organization
BLACKHAWK MANGUM, LLC
Active
Organization
BLACKHAWK MANGUM, LLC
Active
Parent organization
BLACKHAWK MANGUM, LLC
Other names
Altus Radiology Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
BLACKHAWK MANGUM, LLC
Authorized official
TOMMY JOHNSON (CEO)
(580) 782-3353
Entity
Organization
Contact information
Practice address
1 WICKERSHAM ST, MANGUM, OK 73554-9117
(580) 782-3353
(580) 782-5944
Mailing address
3000 N MAIN ST, SUITE 100, ALTUS, OK 73521-1348
(580) 477-2674
(580) 477-2598
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
2208
OK
Other
Enumeration date
03/30/2017
Last updated
03/30/2017
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