BEAR LAKE COMMUNITY HEALTH CENTERS (NPI# 1649546938) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649546938 |
| Entity Type | Organization |
| Organization Name | BEAR LAKE COMMUNITY HEALTH CENTERS |
| Other Organization Name | CACHE VALLEY COMMUNITY HEALTH CENTER-SOUTH |
| Practice Address |
517 W 100 N Ste 110 Providence UT 84332-9826 |
| Mailing Address |
517 W 100 N Ste 210 Providence UT 84332-9826 |
| Practice Telephone | 4357556075 |
| Practice Fax Number | 4359948362 |
| Mailing Telephone | 4357556061 |
| Mailing Fax Number | 4359948362 |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2019-06-11 |
| Authorized Official Name | MR. LAVAL JENSEN (CEO) |
| Authorized Official Telephone | 4357556061 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Cache Valley Community Health Center-South | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417305087 | Bear Lake Community Health Centers | Clinic/Center | 944 S State Highway 89, Logan, UT 84321-5436 | 2016-05-24 |
| 1235495771 | Bear Lake Community Health Centers | Clinic/Center | 75 Yellow Creek Rd, Suite 102, Evanston, WY 82930-5235 | 2012-04-10 |
| Street Address |
517 W 100 N STE 110 |
| City | PROVIDENCE |
| State | UT |
| Zip Code | 84332-9826 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144281122 | Glenn L. Robertson | Family Medicine | 517 W 100 N Ste 110, Providence, UT 84332-9826 | 2006-03-30 |
| 1851916464 | Naomi Landry | Physician Assistant | 517 W 100 N Ste 110, Providence, UT 84332-9826 | 2020-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881292167 | 3bc Incorporated | Pharmacy | 435 North Gateway Drive #802, Providence, UT 84332 | 2020-10-09 |
| 1962049932 | Wholelife Family Wellness Clinic of Providence Pllc | Counselor | 169 N Gateway Dr. Suite 170, Providence, UT 84332 | 2019-12-09 |
| 1033503420 | Spring Creek Surgical Center, LLC | Clinic/Center | 65 North Gateway Drive, Suite 3, Providence, UT 84332 | 2015-03-24 |
| 1558751438 | Naturopathic Medical, P.C. | Naturopath | 565 W. 465 N., Suite 150, Providence, UT 84332 | 2015-01-29 |
| 1821421710 | Erin Campbell | Physical Therapist | 267 West Spring Creek Parkway, Providence, UT 84332 | 2013-08-14 |
| 1285981530 | Jordan Joseph Hansen | Dentist | 169 N Gateway Drive, Suite 200, Providence, UT 84332 | 2012-08-06 |
| 1598086720 | Cory B Maughan | Dermatology | 169 N Gateway Dr Ste 100, Providence, UT 84332 | 2010-06-22 |
| 1528299245 | South Valley Eyecare Center, Inc. | Optometrist | 276 Springcreek Pkwy, Providence, UT 84332 | 2009-07-29 |
| 1316134356 | Heather Saxton Maughan | Speech-Language Pathologist | 344 E Edgehill Dr, Providence, UT 84332 | 2007-10-03 |
| 1902021538 | Brad L Thomas | Physical Therapist | 169 Spring Creek Park Way, Suite 140, Providnce, UT 84332 | 2007-04-17 |
| Find all providers in zip 84332 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174576342 | The Providence Community Health Centers, Inc. | Clinic/Center | 1 Warren Way, Providence, RI 02905-5000 | 2006-05-18 |
| 1821090358 | The Providence Community Health Centers, Inc. | Clinic/Center | 100 Curtis St, Providence, RI 02909-3623 | 2005-08-15 |
| 1295737666 | The Providence Community Health Centers, Inc. | Clinic/Center | 325 Public St, Providence, RI 02905-2340 | 2005-08-15 |
| 1669474102 | The Providence Community Health Centers, Inc. | Clinic/Center | 40 Candace St, Providence, RI 02908-3747 | 2005-08-15 |
| 1053313593 | The Providence Community Health Centers, Inc | Clinic/Center | 375 Allens Ave, Providence, RI 02905-5010 | 2005-08-15 |
| 1508868035 | The Providence Community Health Centers, Inc. | Clinic/Center | 239 Cranston St, Providence, RI 02907-2406 | 2005-08-15 |
| 1417959867 | The Providence Community Health Centers, Inc | Clinic/Center | 355 Prairie Ave, Providence, RI 02905-5010 | 2005-08-15 |
| 1083138572 | The Providence Community Health Centers, Inc | Clinic/Center | 1 Randall Sq, Providence, RI 02904-2709 | 2017-07-27 |
| 1215478219 | The Providence Community Health Centers, Inc. | Clinic/Center | 335 Prairie Ave, Providence, RI 02905-1924 | 2017-03-10 |
| 1558650986 | The Providence Community Health Centers Inc. | Clinic/Center | 530 N Main St, Providence, RI 02904-5762 | 2011-04-06 |
| Find all providers in PROVIDENCE | ||||
| City | PROVIDENCE |
| Zip Code | 84332 |
Please comment or provide details below to improve the information on BEAR LAKE COMMUNITY HEALTH CENTERS.
| 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.