| Organization Name: | BLACKHAWK MANGUM LLC |
| NPI Number: | 1992737613 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAYNA HEINE (CREDENTIAL) |
| Mailing Address: | One Wickersham Dr Mangum |
| State: | OK US |
| Postal Code: | 735549117 |
| Phone Number: | 5807823353 |
| Fax Number: | 5807825944 |
| NPI Enumeration Date: | 07/06/2006 |
| NPI Last Update Date: | 11/19/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NC0060X |
| License Number: | 2208 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Critical Access |
| Taxonomy Definition: | |