Healthcare Provider Details

I. General information

NPI: 1487770814
Provider Name (Legal Business Name): BRISTOW HEALTHCARE PROPERTIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 7TH AVE SUITE 6
BRISTOW OK
74010-2302
US

IV. Provider business mailing address

700 W 7TH AVE SUITE 6
BRISTOW OK
74010-2302
US

V. Phone/Fax

Practice location:
  • Phone: 918-367-2215
  • Fax: 918-392-1995
Mailing address:
  • Phone: 918-367-2215
  • Fax: 918-392-1995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: DAVID M JAMIN
Title or Position: CEO CFO
Credential:
Phone: 918-367-4418