QUARTZ MOUNTAIN MEDICAL CLINIC - MANGUM
NPI 1033388509
Clinic/Center - Primary Care in Mangum, OK
Active since February 28, 2008
About Quartz Mountain Medical Clinic - Mangum NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
QUARTZ MOUNTAIN MEDICAL CLINIC - MANGUM (NPI 1033388509) is a healthcare organization registered as a primary care in Mangum, Oklahoma and active in the NPI registry since February 2008. The organization lists Shana Davenport, Insurance Credentialing Supervisor, as its authorized official.
NPPES Registry Identity
NPI1033388509
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameBLACKHAWK MANGUM, LLC
Location Address118 SOUTH LOUIS TITTLEMangum, OK 73554
Mailing AddressPo Box 280Mangum, OK 73554-0280
Phone(580) 782-2113
Fax(580) 782-2141
Organization SubpartNo
Authorized OfficialShana DavenportInsurance Credentialing Supervisor · (512) 681-3460
Enumeration DateFebruary 28, 2008
Last NPPES UpdateMarch 4, 2009
✔ NPI 1033388509 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in OK · 2208
118 SOUTH LOUIS TITTLE, Mangum, OK 73554
Other Names 1
Doing Business AsQuartz Mountain Medical Clinic - Mangum
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1033388509, enumerated as an "organization" on February 28, 2008.
The provider is located at 118 SOUTH LOUIS TITTLE MANGUM, OK 73554 and the phone number is (580) 782-2113.
Clinic/Center with taxonomy code 261QP2300X and a focus in Primary Care.
