Blackhawk Mangum LLC

NPI #1679966709 in Altus, Oklahoma

Provider Information

NPI Number: 1679966709
Entity Type: Organization
Organization Name: Blackhawk Mangum LLC
Primary Specialty: Clinic/Center
Enumeration Date: Mar 13, 2015
Last Updated: Nov 17, 2015

Practice Location

Address: 3000 N MAIN ST
City: Altus
State: Oklahoma
ZIP Code: 73521-1348
Phone: (580) 782-3353

Authorized Official

Name: KEVIN J OWENS
Title: OWNER
Phone: (580) 782-3353

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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