BLACKHAWK MANGUM LLC NPI 1366611824

NPI Information

  • NPI: 1366611824
  • Provider Name: BLACKHAWK MANGUM, LLC
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • Doing Business As: QUARTZ MOUNTAIN MEDICAL CENTER - HOLLIS
  • Address: 513 EAST CHESTNUT
    HOLLIS, OK
    ZIP 73550
  • Phone: (580) 688-3314

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NPI Details

BLACKHAWK MANGUM, LLC is a primary care clinic center in Hollis, OK. BLACKHAWK MANGUM, LLC NPI is 1366611824. The provider is registered as an organization entity type.
The provider Is Doing Business As Quartz Mountain Medical Center - Hollis.

The provider's business location address is:

513 EAST CHESTNUT
HOLLIS, OK
ZIP 73550
Phone: (580) 688-3314
Fax: (580) 688-9530

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 2/28/2008 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
1261QP2300XClinic/CenterPrimary Care2208OKLAHOMAYes

What is NPI?

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

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