Organization
PHYSICIANS CHOICE DIALYSIS OF BRISTOW LLC
Active
Other names
PCD Bristow
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY SMITH (DIRECTOR OF LEGAL)
(610) 495-8900
Entity
Organization
Contact information
Practice address
402 S MAIN ST, BRISTOW, OK 74010-3204
(610) 495-8900
(610) 495-8560
Mailing address
211 COMMERCE CT, SUITE 104, POTTSTOWN, PA 19464-3483
(610) 495-8900
(610) 495-8560
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200486820A
—
AL
Enumeration date
10/15/2011
Last updated
02/06/2015
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