Organization Name: | PHYSICIANS CHOICE DIALYSIS OF BRISTOW LLC |
NPI Number: | 1518242015 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KELLY SMITH (DIRECTOR OF LEGAL) |
Mailing Address: | 402 S Main St Bristow |
State: | OK US |
Postal Code: | 740103204 |
Phone Number: | 6104958900 |
Fax Number: | 6104958560 |
NPI Enumeration Date: | 10/15/2011 |
NPI Last Update Date: | 02/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |