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General NPI Number Information
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NPI Number | 1891856894
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Entity Type | Organization
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Legal Business Name | BRISTOL BAY AREA HEALTH CORPORATION
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 357 MAIN STREET
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City | KING SALMON
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State | AK
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Zip | 99613-0000
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Country | US
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Telephone | 907-842-5201
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Fax | 907-842-9250
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Provider Business Mailing Address
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Address Line | 6000 KANAKANAK RD
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City | DILLINGHAM
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State | AK
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Zip | 99576
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Country | US
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Telephone | 907-842-5201
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Fax | 907-842-9250
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Authorized Official
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Title or Position | CEO
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Name | MR. ROBERT CLARK
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Credential |
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Telephone | 907-842-5201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 920044692
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License Number State | AK
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