BLACKHAWK MANGUM, LLC (NPI# 1760890040) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760890040 |
| Entity Type | Organization |
| Organization Name | BLACKHAWK MANGUM, LLC |
| Other Organization Name | QUARTZ MOUNTAIN HEALTHCARE SYSTEM - ROBINSON FAMILY CLINIC |
| Practice Address |
1601 Watts St Sayre OK 73662-1314 |
| Mailing Address |
1 Wickersham St Mangum OK 73554-9117 |
| Practice Telephone | 5809289933 |
| Mailing Telephone | 5807823353 |
| Mailing Fax Number | 5807825944 |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2014-09-08 |
| Authorized Official Name | MRS. LINDSAY CRABB (CEO) |
| Authorized Official Telephone | 5807823353 |
| Authorized Official Credential | CEO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Quartz Mountain Healthcare System - Robinson Family Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366611824 | Blackhawk Mangum, LLC | Clinic/Center | 513 East Chestnut, Hollis, OK 73550 | 2008-02-28 |
| 1033388509 | Blackhawk Mangum, LLC | Clinic/Center | 118 South Louis Tittle, Mangum, OK 73554 | 2008-02-28 |
| 1093247082 | Blackhawk Mangum, LLC | Clinic/Center | 1 Wickersham St, Mangum, OK 73554-9117 | 2017-03-30 |
| 1811351703 | Blackhawk Mangum, LLC | Clinic/Center | 1 Wickersham St, Mangum, OK 73554-9117 | 2016-04-07 |
| 1316326770 | Blackhawk Mangum, LLC | Clinic/Center | 1 Wickersham St, Mangum, OK 73554-9117 | 2015-05-19 |
| 1093986937 | Blackhawk Mangum, LLC | Emergency Medicine | One Wickersham Dr, Mangum, OK 73554 | 2008-03-19 |
| 1922147305 | Blackhawk Mangum, LLC | General Acute Care Hospital | 417 North Main St, Granite, OK 73547 | 2007-02-05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oklahoma Business Registrations | BLACKHAWK MANGUM, LLC | 1 Wickersham Dr, Mangum, OK 73554 |
| Street Address |
1601 WATTS ST |
| City | SAYRE |
| State | OK |
| Zip Code | 73662-1314 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235215807 | Sam Thornbrough | Pharmacy | 1601 Watts St, Sayre, OK 73662-1314 | 2006-10-27 |
| 1710378294 | Blackhawk Mangum LLC | Clinic/Center | 1601 Watts St, Sayre, OK 73662-1314 | 2015-02-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194275883 | Kandace Lindsay | Peer Specialist | 501 E Grand, Sayre, OK 73662 | 2016-10-06 |
| 1124251624 | Katrina Lavern Hinds | Counselor | 501 E. Grand, Sayre, OK 73662 | 2009-08-31 |
| 1376762757 | K E Whinery Md PC | Family Medicine | 1505 North Watts, Sayre, OK 73662 | 2007-04-24 |
| 1093837767 | Sayre Health Care Inc | Skilled Nursing Facility | 1 Quarter Mile E of Court House, Sayre, OK 73662 | 2007-04-04 |
| 1174680482 | Dr. Brad Park Pllc | Chiropractor | 307 N.e. Hwy 66, Sayre, OK 73662 | 2007-01-03 |
| 1124104781 | Sonya` K Carlson | Pharmacist | 1601 N Watts St, Sayre, OK 73662 | 2006-10-27 |
| 1669558201 | Sam F Thornbrough | Pharmacist | 1601 N. Watts St., Sayre, OK 73662 | 2006-10-27 |
| 1417966284 | Roy Leaford Thornbrough | Dentist | 1605 North Watts Street, Sayre, OK 73662 | 2006-08-07 |
| 1346231826 | Sayre Public Schools | Public Health or Welfare | 716 Ne 66th St, Sayre, OK 73662 | 2005-11-02 |
| 1447247721 | Sayre Health Care | Nursing Care | 1/4 Mi E of Courthouse On Hwy 152, Sayre, OK 73662 | 2005-10-03 |
| Find all providers in zip 73662 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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|---|---|---|---|---|
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| 1881292191 | Team Clinic Management Partners LLC | Clinic/Center | 3100 W New Orleans St, Broken Arrow, OK 74011-1468 | 2020-10-09 |
| 1972115392 | Team Clinic Management Partners LLC | Clinic/Center | 225 E Omaha St, Broken Arrow, OK 74012-1761 | 2020-08-18 |
| 1093327413 | Team Clinic Management Partners LLC | Clinic/Center | 301 W New Orleans St, Broken Arrow, OK 74011-2206 | 2020-08-18 |
| 1962013110 | Team Clinic Management Partners LLC | Clinic/Center | 4300 E Gary Street, Broken Arrow, OK 74014 | 2020-08-12 |
| 1750992038 | Team Clinic Management Partners LLC | Clinic/Center | 251 E Omaha St, Broken Arrow, OK 74012-1761 | 2020-08-11 |
| 1689285975 | Team Clinic Management Partners LLC | Clinic/Center | 301 E Tucson St, Broken Arrow, OK 74011-7235 | 2020-08-11 |
| 1417568700 | Team Clinic Management Partners LLC | Clinic/Center | 1351 E Albany St, Broken Arrow, OK 74012-8995 | 2020-08-11 |
| 1164033569 | Team Clinic Management Partners LLC | Clinic/Center | 6800 E Quincy Pl, Broken Arrow, OK 74014-4523 | 2020-08-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.