Healthcare Provider Details

I. General information

NPI: 1629105804
Provider Name (Legal Business Name): BRISTOL BAY BOROUGH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SCHOOL ROAD
NAKNEK AK
99633-0211
US

IV. Provider business mailing address

PO BOX 211 # 2 SCHOOL ROAD
NAKNEK AK
99633-0211
US

V. Phone/Fax

Practice location:
  • Phone: 907-246-6155
  • Fax: 907-246-6158
Mailing address:
  • Phone: 907-246-6155
  • Fax: 907-246-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateAK

VIII. Authorized Official

Name: MS. SUSAN COX
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 907-246-6155