Provider Demographics
NPI:1073841623
Name:BRISTOW MEDICAL CENTER OPERATING COMPANY
Entity Type:Organization
Organization Name:BRISTOW MEDICAL CENTER OPERATING COMPANY
Other - Org Name:BRISTOW MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTH OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EARNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-367-2215
Mailing Address - Street 1:700 W 7TH AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-2302
Mailing Address - Country:US
Mailing Address - Phone:918-367-2215
Mailing Address - Fax:
Practice Address - Street 1:700 W 7TH AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-2302
Practice Address - Country:US
Practice Address - Phone:918-367-2215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit