Bear Lake Community Health Center, Inc.
Organization Active NPI Family Medicine Physician · Garden City, UT
NPI 1629309786 · NPPES record last updated Jun 6, 2022
Key facts
- NPI
- 1629309786
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- BEAR LAKE COMMUNITY HEALTH CENTER, INC.
- Practice address
- 325 West Logan Highway
Garden City, UT 84028-8001 - Phone
- (435) 946-3660
- Fax
- (435) 946-8215
- NPI assigned
- Jan 28, 2010
- Organization subpart
- No
Authorized official
- Name
- Jorge Garcia
- Title
- Ceo
- Phone
- (435) 755-6061
Other NPIs on the same Medicare enrollment 2
Practitioners 5
-
Ben P Boyer, FNP
-
Suezan L Johnson, LCSW
-
Florin Rex Nielsen Jr., M.D.
-
Mark C. Weston, DDS
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040110000158 | UT | Part B Supplier - Clinic/Group Practice | 9032020037 |
Receives reassigned benefits from 20 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Providence, UT; Randolph, UT; North Logan, UT; Garden City, UT; Brigham City, UT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker |
104100000X | |||
| Marriage & Family Therapist |
106H00000X | |||
| Dentist |
122300000X | |||
| General Practice Dentistry |
1223G0001X | |||
| Registered Dietitian |
133V00000X | |||
| Optometrist |
152W00000X | |||
| Psychiatric Pharmacist |
1835P1300X | |||
| Family Medicine Physician |
207Q00000X | Yes | ||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Child & Adolescent Psychiatry Physician |
2084P0804X | |||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X | |||
| Family Nurse Practitioner |
363LF0000X | |||
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X |
Addresses
Primary practice location
325 West Logan Highway
Garden City, UT 84028-8001
Mailing address
517 W 100 N Ste 210
Providence, UT 84332-9826
Phone (435) 755-6061
Other practice location 1
2620 Commercial Way Ste 140
Rock Springs, WY 82901-4750
Phone (435) 755-6061
Other practice location 2
1515 N 400 E Ste 104
North Logan, UT 84341-7595
Phone (435) 755-6061
Other practice location 3
75 Yellow Creek Rd Ste 102
Evanston, WY 82930-5205
Phone (435) 755-6061
Other practice location 4
152 S 4th St
Montpelier, ID 83254-1538
Phone (435) 755-6061
Other practice location 5
5 W 200 N
Brigham City, UT 84302-2109
Phone (435) 755-6061
Other practice location 6
120 S Main St
Randolph, UT 84064-7701
Phone (435) 755-6061
Other practice location 7
517 W 100 N Ste 110
Providence, UT 84332-9826
Phone (435) 755-6061
Other names
- Bear Lake Community Health Center
- Bear Lake Community Health Center- Montpelier
- Bear Lake Community Health Center- Randolph
- Box Elder Community Health Center
- Cache Valley Community Health Center
- Cache Valley Community Health Center- Providence
- Evanston Community Health Center
- Rock Springs Community Health Center
Other providers in Garden City, UT
- Bear Lake Community Health Center Pharmacy
- Bear Lake Community Health Center, Inc.
- Bear Lake County Memorial Hospital
- Bear Lake Drug Garden City
- Bear Lake Physical and Sports Therapy PC
- Benjamin Charles Bosen
All providers in Garden City, UT · Family Medicine Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.