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BLACKHAWK MANGUM, LLC
NPI 1093986937
Family Medicine in Mangum, OK

Active since March 19, 2008
ONE WICKERSHAM DR, MANGUM, OK 73554(580) 782-3353(580) 782-2811 Get Directions Write a Review

NPPES record last updated: July 23, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Blackhawk Mangum, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLACKHAWK MANGUM, LLC (NPI 1093986937) is a healthcare organization registered as a family medicine in Mangum, Oklahoma and active in the NPI registry since March 2008. The organization lists Shana Davenport, Insurance Credentialing Supervisor, as its authorized official.

NPPES Registry Identity

NPI1093986937
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameBLACKHAWK MANGUM, LLC
Location AddressONE WICKERSHAM DRMangum, OK 73554
Mailing AddressPo Box 280Mangum, OK 73554
Phone(580) 782-3353
Fax(580) 782-2811
Organization SubpartNo
Authorized OfficialShana DavenportInsurance Credentialing Supervisor · (512) 681-3460
Enumeration DateMarch 19, 2008
Last NPPES UpdateJuly 23, 2008
✔ NPI 1093986937 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in OK · 2208
Definition

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.

Also ListedEmergency MedicineTaxonomy 207P00000X · License 2208 (OK)
Also ListedPhysician AssistantTaxonomy 363A00000X · License 2208 (OK)
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License 2208 (OK)
ONE WICKERSHAM DR, Mangum, OK 73554
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BLACKHAWK MANGUM LLC
General Acute Care Hospital (Critical Access)
ONE WICKERSHAM DR
MANGUM, OK 73554
Greer County (580) 782-3353

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blackhawk Mangum, LLC's NPI number?

The NPI number for Blackhawk Mangum, LLC is 1093986937. It was assigned to this organization in the NPPES registry on March 19, 2008.

Where is Blackhawk Mangum, LLC located?

Blackhawk Mangum, LLC is located at One Wickersham Dr, Mangum, OK 73554. The listed phone number is (580) 782-3353.

What is Blackhawk Mangum, LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Blackhawk Mangum, LLC was last updated on July 23, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.