Provider Demographics
NPI:1730414244
Name:BRISTOW MEDICAL CENTER OPERATING COMPANY
Entity type:Organization
Organization Name:BRISTOW MEDICAL CENTER OPERATING COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFCIAL
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EARNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-367-2215
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5821Medicare PIN