# BRISTOW ENDEAVOR HEALTHCARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BRISTOW ENDEAVOR HEALTHCARE, LLC
- **Other names:** Prague Healthcare Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1275093098
- **Legal business name:** BRISTOW ENDEAVOR HEALTHCARE, LLC
- **Authorized official:** MELINDA KAY WHITAKER (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (918) 701-2313

## Contact information

- **Practice address:** 810 9TH ST, PRAGUE, OK 74864-4582
- **Practice address phone:** (405) 566-3411
- **Practice address fax:** (405) 566-3410
- **Mailing address:** 1809 E 13TH ST STE 300, TULSA, OK 74104-4431
- **Mailing address phone:** (918) 701-2313
- **Mailing address fax:** (539) 235-0028

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/20/2019
- **Last updated:** 05/30/2023