BEAR LAKE COMMUNITY HEALTH CENTER (NPI# 1568732501) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568732501 |
| Entity Type | Organization |
| Organization Name | BEAR LAKE COMMUNITY HEALTH CENTER |
| Other Organization Name | EVANSTON COMMUNITY HEALTH CENTER PHARMACY |
| Practice Address |
75 Yellow Creek Rd # S-102 Evanston WY 82930-5235 |
| Mailing Address |
1515 N 400 E Ste 104 North Logan UT 84341-7595 |
| Practice Telephone | 3077898291 |
| Practice Fax Number | 3077892105 |
| Mailing Telephone | 4357558424 |
| Mailing Fax Number | 4357558436 |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2016-04-12 |
| Authorized Official Name | LAVAL JENSON (CEO) |
| Authorized Official Telephone | 4357556061 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
R10072 | WY | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2132905 | 01 |
| Other Name | Type Code |
|---|---|
| Evanston Community Health Center Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336705755 | Bear Lake Community Health Center | Pharmacy | 517 W 100 N Ste 210, Providence, UT 84332-9826 | 2019-05-10 |
| 1285140376 | Bear Lake Community Health Center | Pharmacy | 75 Yellow Creek Rd Ste 102, Evanston, WY 82930-5205 | 2017-12-27 |
| 1922514017 | Bear Lake Community Health Center | Pharmacy | 2620 Commercial Way Ste 121, Rock Springs, WY 82901-4746 | 2017-12-27 |
| 1083886865 | Bear Lake Community Health Center | Pharmacy | 1515 N 400 E, Suite 104, North Logan, UT 84341-7561 | 2008-04-01 |
| 1689754475 | Bear Lake Community Health Center | Clinic/Center | 325 W. Logan Hwy, Garden City, UT 84028-0328 | 2006-10-16 |
| 1740383884 | Bear Lake Community Health Center | Pharmacy | 325 W Logan Hwy, Garden City, UT 84028 | 2006-09-06 |
| 1063940344 | Bear Lake Community Health Center | Clinic/Center | 2620 Commercial Way, Rock Springs, WY 82901-4671 | 2017-05-31 |
| 1558806125 | Bear Lake Community Health Center | Clinic/Center | 5 W 200 N, Brigham City, UT 84302-2109 | 2017-01-05 |
| 1861949679 | Bear Lake Community Health Center | Pharmacy | 152 S 4th St, Montpelier, ID 83254-1538 | 2016-09-09 |
| 1003264664 | Bear Lake Community Health Center | Clinic/Center | 152 S 4th St, Montpelier, ID 83254-1538 | 2016-05-24 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | BEAR LAKE COMMUNITY HEALTH CENTER, INC. | 325 W Logan Hwy, Garden City, UT 84028 |
| Street Address |
75 YELLOW CREEK RD # S-102 |
| City | EVANSTON |
| State | WY |
| Zip Code | 82930-5235 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598398935 | Colby Kim Gomez | Physical Therapist | 190 Arrowhead Dr, Evanston, Wy 82930, Evanston, WY 82930 | 2020-02-13 |
| 1164808382 | Marilyn Carol Edgeworth Tacoma | Registered Nurse | 1037 Morse Lee St, Evanston, WY 82930 | 2015-08-11 |
| 1699159723 | Impact Physical Therapy LLC | Clinic/Center | 96 Yellow Creek Road, Evanston, WY 82930 | 2015-07-18 |
| 1578942421 | Mark Carstensen | Case Manager/Care Coordinator | 219 7th Street, Evanston, WY 82930 | 2015-05-26 |
| 1013396241 | Jennifer Carstensen | Case Manager/Care Coordinator | 325 Arrowhead Drive, Evanston, WY 82930 | 2015-05-20 |
| 1780083782 | Christa Lena Barker | Nurse Practitioner | 191 Overthrust Road, Evanston, WY 82930 | 2014-08-15 |
| 1366865339 | Don Mckay Francom | Dentist | 170 Arrowhead Dr. Suite 1, Evanston, WY 82930 | 2014-01-28 |
| 1417228370 | Premier Surgical Center, LLC | Clinic/Center | 195 Overthrust Road, Evanston, WY 82930 | 2012-01-24 |
| 1588959324 | Mejia D Williams | Social Worker | 190 Overthrust Road, Evanston, WY 82930 | 2011-06-09 |
| 1225327000 | Richard Jay Capener | Family Medicine | 196 Arrowhead Dr Ste 1, Evanston, WY 82930 | 2011-04-01 |
| Find all providers in zip 82930 | ||||
| Taxonomy Code | 3336C0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Clinic Pharmacy |
| A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629543152 | Community Health Center of Central Wyoming Inc | Pharmacy | 5000 Blackmore Rd, Casper, WY 82609-3345 | 2018-10-11 |
| 1649660671 | Weston County Hospital District | Pharmacy | 1124 Washington Blvd, Newcastle, WY 82701-2972 | 2015-01-29 |
Please comment or provide details below to improve the information on BEAR LAKE COMMUNITY HEALTH CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.