Organization
BLACKHAWK MANGUM LLC
Active
Organization
BLACKHAWK MANGUM LLC
Active
Other names
Quartz Mountain Medical Center Altus Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN J OWENS (OWNER)
(580) 782-3353
Entity
Organization
Contact information
Practice address
3000 N MAIN ST, ALTUS, OK 73521-1348
(580) 782-3353
Mailing address
1 WICKERSHAM ST, MANGUM, OK 73554-9117
(580) 782-3353
(580) 782-5944
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
03/13/2015
Last updated
11/17/2015
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