# BLACKHAWK MANGUM LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Quartz Mountain Medical Clinic Mangum
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295069151
- **Authorized official:** JAN WINTER (CEO)
- **Authorized official phone:** (580) 782-3353

## Contact information

- **Practice address:** 118 S LOUIS TITTLE AVE, MANGUM, OK 73554-4441
- **Practice address phone:** (580) 782-3353
- **Mailing address:** PO BOX 280, MANGUM, OK 73554-0280
- **Mailing address phone:** (580) 782-3353

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/25/2009
- **Last updated:** 09/25/2009