Organization
BLACKHAWK MANGUM LLC
Active
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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