Blackhawk Mangum, LLC

NPI #1093986937 in Mangum, Oklahoma

Provider Information

NPI Number: 1093986937
Entity Type: Organization
Organization Name: Blackhawk Mangum, LLC
Primary Specialty: Family Medicine
Enumeration Date: Mar 19, 2008
Last Updated: Jul 23, 2008

Practice Location

Address: ONE WICKERSHAM DR
City: Mangum
State: Oklahoma
ZIP Code: 73554
Phone: (580) 782-3353

Authorized Official

Name: SHANA DAVENPORT
Title: INSURANCE CREDENTIALING SUPERVISOR
Phone: (512) 681-3460

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Emergency Medicine	207P00000X
Physician Assistant	363A00000X
Nurse Practitioner - Family — Family	363LF0000X
Family Medicine	207Q00000X	Primary

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