BEAR LAKE COMMUNITY HEALTH CENTER (NPI# 1689754475) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1689754475 |
Entity Type | Organization |
Organization Name | BEAR LAKE COMMUNITY HEALTH CENTER |
Practice Address |
325 W. Logan Hwy Garden City UT 84028-0328 |
Mailing Address |
1515 N 400 E Ste 104 North Logan UT 84341-7595 |
Practice Telephone | 4359463660 |
Practice Fax Number | 4359468215 |
Mailing Telephone | 4357556061 |
Mailing Fax Number | 4357556091 |
Enumeration Date | 2006-10-16 |
Last Update Date | 2016-07-07 |
Authorized Official Name | LAVAL B JENSEN (EXCECUTIVE DIRECTOR) |
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 |
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 |
1568732501 | Bear Lake Community Health Center | Pharmacy | 75 Yellow Creek Rd # S-102, Evanston, WY 82930-5235 | 2012-01-09 |
1083886865 | Bear Lake Community Health Center | Pharmacy | 1515 N 400 E, Suite 104, North Logan, UT 84341-7561 | 2008-04-01 |
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 |
325 W. LOGAN HWY |
City | GARDEN CITY |
State | UT |
Zip Code | 84028-0328 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1821216722 | David Jay Ballingham | Physician Assistant | 325 W. Logan Hwy, Garden City, UT 84028 | 2007-04-23 |
1669690566 | Cardon Weston Willis | Dentist | 325 W. Logan Hwy, Garden City, UT 84028 | 2007-04-23 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1255597043 | Nathan Gracey | Physician Assistant | 325 W. Logan Highway, Garden City, UT 84028 | 2008-08-01 |
1518187798 | Fred H Denison | Social Worker | 325 West Logan Highway, Garden City, UT 84028 | 2007-04-27 |
1710073523 | Kam E Jarman | Physical Therapist | 95 West 50 South, Garden City, UT 84028 | 2006-10-05 |
1861587081 | Bear Lake Community Health Center Pharmacy | Clinic/Center | 325 West Logan Hwy., Garden City, UT 84028 | 2006-10-04 |
1740383884 | Bear Lake Community Health Center | Pharmacy | 325 W Logan Hwy, Garden City, UT 84028 | 2006-09-06 |
1508349465 | Miles David Roberts | Pharmacist | 325 West Logan Highway, Garden City, UT 84028 | 2018-09-06 |
1891947594 | Darrell George Smith | Dentist | 325 West Logan Highway, Garden City, UT 84028 | 2008-10-14 |
1063508885 | Bryce S Woodfield | Physical Therapist | 95 West 50 South, Garden City, UT 84028 | 2006-10-05 |
1669568481 | Bear Lake Physical and Sports Therapy PC | Physical Therapist | 95 West 50 South, Garden City, UT 84028-0276 | 2006-10-05 |
1629309786 | Bear Lake Community Health Center | Nurse Practitioner | 325 West Logan Highway, Garden City, UT 84028-8001 | 2010-01-28 |
Find all providers in zip 84028 |
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 |
---|---|---|---|---|
1083752935 | United Methodist Western Kansas Mexican American Ministries, Inc. | Clinic/Center | 2510 N Henderson Dr, Garden City, KS 67846-3624 | 2007-02-02 |
1619419447 | United Methodist Western Kansas Mexican American Ministries,inc. | Clinic/Center | 801 N Campus Dr, Garden City, KS 67846-6333 | 2016-11-10 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1871014092 | Wayne Community Health Centers, Inc | Clinic/Center | 65 North Center Street, Escalante, UT 84776-0276 | 2017-06-28 |
1417305087 | Bear Lake Community Health Centers | Clinic/Center | 944 S State Highway 89, Logan, UT 84321-5436 | 2016-05-24 |
1780090944 | Southwest Utah Community Health Center, Inc. | Clinic/Center | 391 North 200 West, Hurricane, UT 84737-1616 | 2014-07-09 |
1548588247 | Southwest Utah Community Health Center, Inc | Clinic/Center | 74 W. Harding Ave, Cedar City, UT 84720 | 2010-05-06 |
1528128899 | Wasatch Homeless Health Care, Inc. | Clinic/Center | 409 W 400 S, Salt Lake City, UT 84101-1135 | 2006-12-09 |
1942317722 | Green River Medical Center Inc | Clinic/Center | 585 West Main St., Box 417, Green River, UT 84525-0417 | 2006-08-25 |
1659358687 | Southwest Utah Community Health Center | Clinic/Center | 25 N 100 E, Suite 102, St George, UT 84770 | 2005-12-30 |
1366447112 | Community Health Centers Inc. | Clinic/Center | 1365 W 1000 N, Slc, UT 84116-1654 | 2005-06-17 |
1477558237 | Community Health Centers Inc. | Clinic/Center | 8446 Harrison St, Midvale, UT 84047-3568 | 2005-06-17 |
1144834771 | Carbon Medical Service Assocation, Incorporated | Clinic/Center | 305 Center St, East Carbon, UT 84520-7726 | 2020-09-01 |
Find all providers with the same taxonomy |
City | GARDEN CITY |
Zip Code | 84028 |
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.