Provider Demographics
NPI:1851735559
Name:BRISTOL BAY BOROUGH
Entity Type:Organization
Organization Name:BRISTOL BAY BOROUGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-246-4224
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:NAKNEK
Mailing Address - State:AK
Mailing Address - Zip Code:99633-0189
Mailing Address - Country:US
Mailing Address - Phone:907-246-4224
Mailing Address - Fax:907-246-6633
Practice Address - Street 1:MILE 0 AK PENINSULA HWY
Practice Address - Street 2:
Practice Address - City:NAKNEK
Practice Address - State:AK
Practice Address - Zip Code:99633
Practice Address - Country:US
Practice Address - Phone:907-246-4224
Practice Address - Fax:907-246-6633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1609363Medicaid
AKK165390Medicare PIN