Organization · Type 2 NPI
Blackhawk Mangum, LLC
Primary Care Clinic/Center · Hollis, OK
NPI number
1366611824
Active
Practice location
513 East Chestnut
Hollis, OK 73550
Fax (580) 688-9530
Mailing address
PO Box 280
Mangum, OK 73554-0280
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Primary Care Clinic/Center Primary | 261QP2300X | 2208 (OK) |
Primary Care Clinic/Center: Definition to come...
About NPI 1366611824
Blackhawk Mangum, LLC's National Provider Identifier is 1366611824, issued on Feb 28, 2008. The primary taxonomy on file is Primary Care Clinic/Center (261QP2300X), and the practice location is in Hollis, OK. The record was last updated on Jul 23, 2008.