Organization
BLACKHAWK MANGUM, LLC
Active
Other names
Quartz Mountain Medical Clinic - Mangum
Organization subpart
No
Provider details
NPI number
Authorized official
SHANA DAVENPORT (INSURANCE CREDENTIALING SUPERVISOR)
(512) 681-3460
Entity
Organization
Contact information
Practice address
118 SOUTH LOUIS TITTLE, MANGUM, OK 73554
(580) 782-2113
(580) 782-2141
Mailing address
PO BOX 280, MANGUM, OK 73554-0280
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
2208
OK
Other
Enumeration date
02/28/2008
Last updated
03/04/2009
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