MEDICARE: BRISTOL BAY AREA HEALTH CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1841872090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRISTOL BAY AREA HEALTH CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 130
Second Line	:
City	:	DILLINGHAM
State	:	AK
Zip	:	99576-0130
Country	:	US
Telephone Number	:	907-842-5201
Fax Number	:	907-842-9250

Provider Business Practice Location Address
First Line	:	49 MAIN STREET
Second Line	:
City	:	CLARKS POINT
State	:	AK
Zip	:	99569
Country	:	US
Telephone Number	:	907-842-1230
Fax Number	:	907-842-5174

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT SPECIALIST
Name	:	CATHY LEEANN TAYLOR
Credential	:
Telephone Number	:	907-842-5201

Provider Enumeration Date	:	04/27/2021
Last Update Date	:	04/30/2021

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