OrganizationActive
Blackhawk Mangum, LLC
NPI 1366611824 · Primary Care Clinic/Center · Hollis, OK
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
Practice location
513 East Chestnut
Hollis, OK 73550
Phone: (580) 688-3314
Fax: (580) 688-9530
Approximate (ZIP-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
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.