Provider Demographics
NPI:1295243749
Name:BRISTOW ENDEAVOR HEALTHCARE, LLC
Entity type:Organization
Organization Name:BRISTOW ENDEAVOR HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-367-2215
Mailing Address - Street 1:700 W. 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:BRISTOW,
Mailing Address - State:OK
Mailing Address - Zip Code:74010
Mailing Address - Country:US
Mailing Address - Phone:918-367-2215
Mailing Address - Fax:918-367-9190
Practice Address - Street 1:2340 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:CUSHING,
Practice Address - State:OK
Practice Address - Zip Code:74023
Practice Address - Country:US
Practice Address - Phone:918-225-6904
Practice Address - Fax:918-225-4559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRISTOW ENDEAVOR HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-18
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty