BLACKHAWK MANGUM LLC NPI 1093986937

NPI Information

  • NPI: 1093986937
  • Provider Name: BLACKHAWK MANGUM, LLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Address: ONE WICKERSHAM DR
    MANGUM, OK
    ZIP 73554
  • Phone: (580) 782-3353

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NPI Details

BLACKHAWK MANGUM, LLC is a family medicine in Mangum, OK. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. BLACKHAWK MANGUM, LLC NPI is 1093986937. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

ONE WICKERSHAM DR
MANGUM, OK
ZIP 73554
Phone: (580) 782-3353
Fax: (580) 782-2811

The provider's authorized official is Shana Davenport .
The authorized official title is Insurance Credentialing Supervisor and has the following contact phone number (512) 681-3460.

The enumeration date for this NPI number is 3/19/2008 and was last updated on 7/23/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207P00000XEmergency Medicine2208OKLAHOMANo
2363A00000XPhysician Assistant2208OKLAHOMANo
3363LF0000XNurse PractitionerFamily2208OKLAHOMANo
4207Q00000XFamily Medicine2208OKLAHOMAYes

What is NPI?

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This page was last updated on: 11/21/2025

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