Organization
BLACKHAWK MANGUM LLC
Active
Other names
Quartz Mountain Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DAYNA HEINE (INSURANCE CREDENTIALING SUPERVISOR)
(979) 830-8529
Entity
Organization
Contact information
Practice address
ONE WICKERSHAM DRIVE, MANGUM, OK 73554
(580) 782-3353
Mailing address
PO BOX 280, MANGUM, OK 73554-0280
Taxonomy
Speciality
Code
Description
License number
State
275N00000X
Medicare Defined Swing Bed Hospital Unit
Primary
2208
OK
Other
Enumeration date
12/03/2007
Last updated
11/19/2009
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