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.

Doing business as

Evanston Community Health Center

Practice address

75 Yellow Creek Rd
Suite 102
Evanston, WY 82930-5235

Phone

(307) 789-8290

Fax

(307) 789-8975

NPI assigned

Apr 10, 2012

Last updated

Jun 1, 2022By the provider in NPPES

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

• Evanston Community Health Center Doing business as

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

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1235495771",
    "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": "75 YELLOW CREEK RD",
            "address_2": "SUITE 102",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829305235",
            "telephone_number": "307-789-8290",
            "fax_number": "307-789-8975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAR LAKE COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-10",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evanston Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Evanston Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Linda E Barnes
• Jared Breck Barton, M.D.
• Jill Roccaro Bass, APRN, CSN
• Hannah Bassett
• Jennifer Beagley
• Bear River Dental (Nathan R. Lester DMD PC)
• Bear River Surgical Clinic Inc
• Bear River Urology, LLC
• Kimberly Anne Begalla, CFNP
• Wayne A Bell, EMT-I

• Federally Qualified Health Center (FQHC) in Evanston, WY
• Providers in Evanston, WY by specialty
• Federally Qualified Health Center (FQHC) in Wyoming

• 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.