Blackhawk Mangum LLC

NPI #1104008168 in Mangum, Oklahoma

Provider Information

NPI Number
1104008168
Entity Type
Organization
Organization Name
Blackhawk Mangum LLC
Primary Specialty
Medicare Defined Swing Bed Unit
Enumeration Date
Dec 3, 2007
Last Updated
Nov 19, 2009

Practice Location

Address
ONE WICKERSHAM DRIVE
City
Mangum
ZIP Code
73554
Phone
(580) 782-3353

Authorized Official

Name
DAYNA HEINE
Title
INSURANCE CREDENTIALING SUPERVISOR
Phone
(979) 830-8529

Specialties & Taxonomy Codes

Specialty
Medicare Defined Swing Bed Unit

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