Organization
BLACKHAWK MANGUM, LLC
Active
Other names
MCH GRANITE FAMILY CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN ROLAND (CFO)
(580) 782-3353
Entity
Organization
Contact information
Practice address
417 NORTH MAIN ST, GRANITE, OK 73547
(580) 535-4615
(580) 535-4466
Mailing address
ONE WICKERSHAM DRIVE, MANGUM, OK 73554
(580) 782-3353
(580) 782-5944
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
2208
OK
Other
Enumeration date
02/05/2007
Last updated
04/20/2008
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