Provider Demographics
NPI:1649779216
Name:BRISTOW ENDEAVOR HEALTHCARE, LLC
Entity Type:Organization
Organization Name:BRISTOW ENDEAVOR HEALTHCARE, LLC
Other - Org Name:CORE PAIN & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:DYBIEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-701-2300
Mailing Address - Street 1:1809 E 13TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4431
Mailing Address - Country:US
Mailing Address - Phone:918-701-2313
Mailing Address - Fax:918-513-7303
Practice Address - Street 1:512 N. FRANKLIN STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JENKS,
Practice Address - State:OK
Practice Address - Zip Code:74037
Practice Address - Country:US
Practice Address - Phone:918-701-2300
Practice Address - Fax:918-417-7104
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRISTOW ENDEAVOR HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-08
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty