Healthcare Provider Details

I. General information

NPI: 1942700919
Provider Name (Legal Business Name): BRISTOW ENDEAVOR HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 N MAIN ST
BRISTOW OK
74010-2016
US

IV. Provider business mailing address

1809 E 13TH ST STE 300
TULSA OK
74104-4431
US

V. Phone/Fax

Practice location:
  • Phone: 918-367-6611
  • Fax: 918-367-9915
Mailing address:
  • Phone: 918-701-2313
  • Fax: 918-513-7303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAN E. WINTER
Title or Position: CEO
Credential:
Phone: 918-367-2215