Provider Demographics
NPI:1659458834
Name:BRISTOW HEALTHCARE PROPERTIES LLC
Entity Type:Organization
Organization Name:BRISTOW HEALTHCARE PROPERTIES LLC
Other - Org Name:BRISTOW MEDICAL CENTER HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CUPPS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-367-5644
Mailing Address - Street 1:124 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-2823
Mailing Address - Country:US
Mailing Address - Phone:918-367-5644
Mailing Address - Fax:918-367-2437
Practice Address - Street 1:124 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-2823
Practice Address - Country:US
Practice Address - Phone:918-367-5644
Practice Address - Fax:918-367-2437
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRISTOW HEALTHCARE PROPERTIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7143251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200044170BMedicaid
OK0003772660001OtherBLUE CROSS BLUE SHIELD
OK377266Medicare Oscar/Certification