Basic Information
| Provider Information | |||||||||
| NPI: | 1508044835 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BARTLETT REGIONAL HOSPITAL | ||||||||
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| OtherOrganizationName: | BARTLETT SURGERY & SPECIALTY CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3225 HOSPITAL DR UNIT 101A | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998017863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077968632 | ||||||||
| FaxNumber: | 9077968455 | ||||||||
| Practice Location | |||||||||
| Address1: | 3225 HOSPITAL DR UNIT 101A | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998017863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077968632 | ||||||||
| FaxNumber: | 9077968455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2008 | ||||||||
| LastUpdateDate: | 02/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | MORROW | ||||||||
| AuthorizedOfficialFirstName: | SHAWN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9077968438 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.