Provider Demographics
NPI:1225216849
Name:AHS BRISTOW HOSPITAL
Entity Type:Organization
Organization Name:AHS BRISTOW HOSPITAL
Other - Org Name:BRISTOW MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-968-4870
Mailing Address - Street 1:700 W 7TH AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-2302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 W 7TH AVE STE 6
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-2302
Practice Address - Country:US
Practice Address - Phone:918-968-4870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371627Medicare Oscar/Certification