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General NPI Number Information
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NPI Number | 1518242015
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Entity Type | Organization
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Legal Business Name | PHYSICIANS CHOICE DIALYSIS OF BRISTOW LLC
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Dates
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Enumeration Date | 10/15/2011
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 402 S MAIN ST
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City | BRISTOW
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State | OK
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Zip | 74010-3204
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Country | US
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Telephone | 610-495-8900
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Fax | 610-495-8560
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Provider Business Mailing Address
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Address Line | 211 COMMERCE CT SUITE 104
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City | POTTSTOWN
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State | PA
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Zip | 19464-3483
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Country | US
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Telephone | 610-495-8900
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Fax | 610-495-8560
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Authorized Official
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Title or Position | DIRECTOR OF LEGAL
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Name | MRS. KELLY SMITH
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Credential |
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Telephone | 610-495-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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