Provider Demographics
NPI:1518932342
Name:BRISTOW HEALTHCARE PROPERTIES, LLC
Entity Type:Organization
Organization Name:BRISTOW HEALTHCARE PROPERTIES, LLC
Other - Org Name:BRISTOW MEMORIAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-367-4418
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:918-392-1995
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:918-392-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2308282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000370041001OtherBCBS OKLAHOMA
OK200044170AMedicaid
OK400522419OtherMEDICARE PART B (LEGACY)
OK400522419OtherMEDICARE PART B (LEGACY)
OK200044170AMedicaid