MEDICARE: BRISTOL HOSPICE - OKLAHOMA, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1043968852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRISTOL HOSPICE - OKLAHOMA, L.L.C.

Provider Business Mailing Address
First Line	:	206 N 2100 W STE 202
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-4741
Country	:	US
Telephone Number	:	801-325-0175
Fax Number	:	801-478-3533

Provider Business Practice Location Address
First Line	:	4005 NW EXPRESSWAY STE 500E
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1691
Country	:	US
Telephone Number	:	405-839-7100
Fax Number	:	405-766-6748

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	ALEX E MAURICIO
Credential	:
Telephone Number	:	801-325-0175

Provider Enumeration Date	:	03/11/2022
Last Update Date	:	03/01/2024

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