Blackhawk Mangum, LLC
NPI #1366611824 in Hollis, Oklahoma
Provider Information
- NPI Number
- 1366611824
- Entity Type
- Organization
- Organization Name
- Blackhawk Mangum, LLC
- Primary Specialty
- Clinic/Center - Primary Care
- Enumeration Date
- Feb 28, 2008
- Last Updated
- Jul 23, 2008
Practice Location
Authorized Official
- Name
- SHANA DAVENPORT
- Title
- INSURANCE CREDENTIALING SUPERVISOR
- Phone
- (512) 681-3460
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Primary Care — Primary Care |
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