| Organization Name: | BLACKHAWK MANGUM LLC |
| NPI Number: | 1295069151 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAN WINTER (CEO) |
| Mailing Address: | 118 S Louis Tittle Ave Mangum |
| State: | OK US |
| Postal Code: | 735544441 |
| Phone Number: | 5807823353 |
| Fax Number: | |
| NPI Enumeration Date: | 09/25/2009 |
| NPI Last Update Date: | 09/25/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |