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Organization
BLACKHAWK MANGUM LLC
Active
Organization
BLACKHAWK MANGUM LLC
Active
Other names
Quartz Mountain Medical Clinic Mangum
Organization subpart
No
Provider details
NPI number
Authorized official
JAN WINTER (CEO)
(580) 782-3353
Entity
Organization
Contact information
Practice address
118 S LOUIS TITTLE AVE, MANGUM, OK 73554-4441
(580) 782-3353
Mailing address
PO BOX 280, MANGUM, OK 73554-0280
(580) 782-3353
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
09/25/2009
Last updated
09/25/2009
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