Bear Lake Community Health Center, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

BEAR LAKE COMMUNITY HEALTH CENTER, INC.

Practice address

152 S 4TH St
Montpelier, ID 83254-1538

Phone

(208) 847-2108

Fax

(208) 847-2109

NPI assigned

May 24, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jorge Garcia

Title

Ceo

Phone

(435) 755-6061

Specialties & licenses 1

Addresses

Other names 1

• Bear Lake Community Health Center-Montpelier Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1003264664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 W 100 N STE 210",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329826",
            "telephone_number": "435-755-6061",
            "fax_number": "354-994-8362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 S 4TH ST",
            "city": "MONTPELIER",
            "state": "ID",
            "postal_code": "832541538",
            "telephone_number": "208-847-2108",
            "fax_number": "208-847-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAR LAKE COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-24",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "JORGE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "435-755-6061"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bear Lake Community Health Center-Montpelier",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bear Lake Community Health Center-Montpelier",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anya Michelle Anthony, P.A.C.
• Trezlyn Bartschi
• Bear Lake County
• Bear Lake County Memorial Hospital
• Bear Lake County Memorial Hospital
• Bear Lake County Memorial Hospital
• Bear Lake County Memorial Hospital

• All providers in Montpelier, ID
• Federally Qualified Health Center (FQHC) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.