Healthcare Provider Details

I. General information

NPI: 1770645202
Provider Name (Legal Business Name): BRISTOL BAY AREA HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 KANAKANAK RD
DILLINGHAM AK
99576-0130
US

IV. Provider business mailing address

PO BOX 130
DILLINGHAM AK
99576-0130
US

V. Phone/Fax

Practice location:
  • Phone: 907-842-5201
  • Fax: 907-842-9250
Mailing address:
  • Phone: 907-842-5201
  • Fax: 907-842-9250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT CLARK
Title or Position: CEO
Credential:
Phone: 907-842-5201