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	282NC0060X	Critical Access Hospital

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TEZ010	OTHER	AK	MEDICARE ID - TYPE UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831270842
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	:	907-842-9454
Fax Number	:	907-842-9203

Provider Business Practice Location Address
First Line	:	6000 KANAKANAK RD.
Second Line	:
City	:	DILLINGHAM
State	:	AK
Zip	:	99576-0130
Country	:	US
Telephone Number	:	907-842-9454
Fax Number	:	907-842-9203

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. ROBERT CLARK
Credential	:
Telephone Number	:	907-842-6502

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	04/07/2011

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1770645202 — BRISTOL BAY AREA HEALTH CORPORATION
Practice Location Address:

6000 KANAKANAK RD
DILLINGHAM, AK
99576-0130

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Practice Fax: 907-842-9250

Directions to “BRISTOL BAY AREA HEALTH CORPORATION ” Practice Location

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