Healthcare Provider Details

I. General information

NPI: 1114435666
Provider Name (Legal Business Name): BRISTOW ENDEAVOR HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3029 W. MAIN STREET
JENKS OK
74037
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 918-701-2300
  • Fax: 918-417-7104
Mailing address:
  • Phone: 918-701-2302
  • Fax: 539-235-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: MELINDA KAY WHITAKER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 918-701-2313