Healthcare Provider Details

I. General information

NPI: 1568151983
Provider Name (Legal Business Name): BARTLETT REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 HOSPITAL DR
JUNEAU AK
99801-7808
US

IV. Provider business mailing address

3260 HOSPITAL DR
JUNEAU AK
99801-7808
US

V. Phone/Fax

Practice location:
  • Phone: 907-796-8498
  • Fax:
Mailing address:
  • Phone: 907-796-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH WANNER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 907-796-8402