OrganizationActive
Blackhawk Mangum, LLC
NPI 1366611824 · Primary Care Clinic/Center · Hollis, OK
Blackhawk Mangum, LLC is a Primary Care Clinic/Center organization in Hollis, OK (NPI 1366611824).
Provider details
- NPI number
- 1366611824
- Entity type
- Organization
- Primary specialty
- Primary Care Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Shana Davenport, Insurance Credentialing Supervisor(512) 681-3460
- License
- 2208 (OK)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Detailed profile(88/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
513 East Chestnut
Hollis, OK 73550
Phone: (580) 688-3314
Fax: (580) 688-9530
Street-level locationGet directions
Mailing address
Po Box 280
Mangum, OK 73554-0280
Other names (DBA / former)
- Doing business as
- Quartz Mountain Medical Center - Hollis
Registry dates
- Enumerated
- 2008-02-28
- Last updated
- 2008-07-23
Frequently asked questions
- What is Blackhawk Mangum, LLC's NPI number?
- Blackhawk Mangum, LLC's National Provider Identifier (NPI) is 1366611824, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Blackhawk Mangum, LLC?
- Blackhawk Mangum, LLC is classified in the NPPES registry as Primary Care Clinic/Center (Ambulatory Health Care Facilities).
- Where is Blackhawk Mangum, LLC located?
- Blackhawk Mangum, LLC's practice location on file with NPPES is 513 East Chestnut, Hollis, OK 73550.
- What is Blackhawk Mangum, LLC's phone number?
- The practice phone number listed in the NPPES registry for Blackhawk Mangum, LLC is (580) 688-3314.
- Who is the authorized official for Blackhawk Mangum, LLC?
- The authorized official listed on Blackhawk Mangum, LLC's NPPES record is Shana Davenport, Insurance Credentialing Supervisor. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Blackhawk Mangum, LLC's NPI active?
- Yes — Blackhawk Mangum, LLC's NPI (1366611824) is active in the NPPES registry as of the last update on 2008-07-23.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.