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	275N00000X	Medicare Defined Swing Bed Hospital Unit

General Provider Information

NPI Number	:	1770645202
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	:	6000 KANAKANAK RD
Second Line	:
City	:	DILLINGHAM
State	:	AK
Zip	:	99576-0130
Country	:	US
Telephone Number	:	907-842-5201
Fax Number	:	907-842-9250

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROBERT CLARK
Credential	:
Telephone Number	:	907-842-5201

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	04/04/2013

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1831270842 — BRISTOL BAY AREA HEALTH CORPORATION
Practice Location Address:

6000 KANAKANAK RD.
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