Basic Information
| Provider Information | |||||||||
| NPI: | 1891849261 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BARTLETT REGIONAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3260 HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998017808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077968900 | ||||||||
| FaxNumber: | 9077968477 | ||||||||
| Practice Location | |||||||||
| Address1: | 3260 HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998017808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077968900 | ||||||||
| FaxNumber: | 9077968477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | KEITH | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9077968900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | AK | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1005539 | 05 | AK | MEDICAID |