BLACKHAWK MANGUM, LLC (NPI# 1811351703) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811351703 |
| Entity Type | Organization |
| Organization Name | BLACKHAWK MANGUM, LLC |
| Other Organization Name | ROBISON CLINIC |
| Practice Address |
1 Wickersham St Mangum OK 73554-9117 |
| Mailing Address |
1415 Watts St Suite 100 Sayre OK 73662-1310 |
| Practice Telephone | 5807823353 |
| Practice Fax Number | 5807825944 |
| Mailing Telephone | 5809282044 |
| Mailing Fax Number | 5809285660 |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2016-04-07 |
| Authorized Official Name | KEVIN OWENS (OWNER) |
| Authorized Official Telephone | 5807823353 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Robison 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 |
| 1316326770 | Blackhawk Mangum, LLC | Clinic/Center | 1 Wickersham St, Mangum, OK 73554-9117 | 2015-05-19 |
| 1760890040 | Blackhawk Mangum, LLC | Clinic/Center | 1601 Watts St, Sayre, OK 73662-1314 | 2014-07-30 |
| 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 |
1 WICKERSHAM ST |
| City | MANGUM |
| State | OK |
| Zip Code | 73554-9117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972716512 | Russell D Berry | Physical Therapy Assistant | 1 Wickersham St, Mangum, OK 73554-9117 | 2007-05-08 |
| 1033635263 | Mangum City Hospital Authority | General Acute Care Hospital | 1 Wickersham St, Mangum, OK 73554-9117 | 2017-08-18 |
| 1093247082 | Blackhawk Mangum, LLC | Clinic/Center | 1 Wickersham St, Mangum, OK 73554-9117 | 2017-03-30 |
| 1316326770 | Blackhawk Mangum, LLC | Clinic/Center | 1 Wickersham St, Mangum, OK 73554-9117 | 2015-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750845145 | Traci L Carrier | Licensed Practical Nurse | 115 S Lincoln St., Mangum, OK 73554 | 2019-01-30 |
| 1194295741 | Ez Sleep Solutions, Inc. | Dentist | 230 E. Jefferson, Mangum, OK 73554 | 2018-11-27 |
| 1881122976 | Lexie Noel Turner | Case Manager/Care Coordinator | 115 E Lincoln, Mangum, OK 73554 | 2017-06-01 |
| 1740640648 | Yco Tulsa, Inc. | Clinic/Center | 2100 North Louis Tittle, Suites 122-124 and 147-148, Mangum, OK 73554 | 2016-03-04 |
| 1750748984 | Teryl Pearson | Counselor | 2 Wickersham Dr., New Hope Recovery Center, Mangum, OK 73554 | 2016-01-19 |
| 1437525532 | Kiley Reneah Bachelder | Case Manager/Care Coordinator | 2 Wichersham Drive, Mangum, OK 73554 | 2015-08-12 |
| 1376941732 | Dana Juarez | Marriage & Family Therapist | 2100 N Louis Tittle, Mangum, OK 73554 | 2014-12-16 |
| 1033388509 | Blackhawk Mangum, LLC | Clinic/Center | 118 South Louis Tittle, Mangum, OK 73554 | 2008-02-28 |
| 1104008168 | Blackhawk Mangum LLC | Medicare Defined Swing Bed Unit | One Wickersham Drive, Mangum, OK 73554 | 2007-12-03 |
| 1336356500 | Patrecia Ann Fite | Nurse Practitioner | 2100 North Louis Tittle Ave, Box 1, Mangum, OK 73554 | 2007-05-17 |
| Find all providers in zip 73554 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316326770 | Blackhawk Mangum, LLC | Clinic/Center | 1 Wickersham St, Mangum, OK 73554-9117 | 2015-05-19 |
| 1699964627 | Tlc of Chiropractic L.L.C. | Clinic/Center | 314 W Lincoln St, Mangum, OK 73554-4604 | 2007-10-16 |
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|---|---|---|---|---|
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| 1154949642 | Osu Center for Health Sciences | Clinic/Center | 140 W 151st St S, Glenpool, OK 74033-4523 | 2020-07-10 |
| 1235757071 | Equality Health Group LLC | Clinic/Center | 4301 Nw 63rd St Ste 109, Oklahoma City, OK 73116-1548 | 2020-07-08 |
| 1538785985 | Stars and Stripes Therapy Inc. | Clinic/Center | 713 Sw C Ave Ste A, Lawton, OK 73501-4311 | 2020-06-22 |
| 1265058101 | Taylor Medical Group, LLP | Clinic/Center | 735 W Locust St, Stilwell, OK 74960-3403 | 2020-06-16 |
| 1891317731 | Sparks Medical Consulting LLC | Clinic/Center | 1604 Sw 38th St, Moore, OK 73160-2953 | 2020-05-14 |
| 1093341844 | Osu Center for Health Sciences | Clinic/Center | 3201 W Gore Blvd Ste G2, Lawton, OK 73505-6323 | 2020-03-12 |
| 1255964128 | Osu Center for Health Sciences | Clinic/Center | 110 Nw 31st St Fl 3, Lawton, OK 73505-6100 | 2020-02-19 |
| 1104458231 | Osu Center for Health Sciences | Clinic/Center | 6501 S Western Ave Ste 101, Oklahoma City, OK 73139-1709 | 2020-02-06 |
| 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.