BEAR LAKE COMMUNITY HEALTH CENTERS (NPI# 1235495771) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235495771 |
| Entity Type | Organization |
| Organization Name | BEAR LAKE COMMUNITY HEALTH CENTERS |
| Other Organization Name | EVANSTON COMMUNITY HEALTH CENTER |
| Practice Address |
75 Yellow Creek Rd Suite 102 Evanston WY 82930-5235 |
| Mailing Address |
517 W 100 N Ste 210 Providence UT 84332-9826 |
| Practice Telephone | 3077898290 |
| Practice Fax Number | 3077898975 |
| Mailing Telephone | 4357556061 |
| Mailing Fax Number | 3549948362 |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2018-09-21 |
| 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 |
|---|---|
| Evanston Community Health Center | 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 |
| 1649546938 | Bear Lake Community Health Centers | Clinic/Center | 517 W 100 N Ste 110, Providence, UT 84332-9826 | 2012-03-30 |
| Street Address |
75 YELLOW CREEK RD SUITE 102 |
| City | EVANSTON |
| State | WY |
| Zip Code | 82930-5235 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922005347 | Michael Dean Adams | Family Medicine | 75 Yellow Creek Rd, Suite 102, Evanston, WY 82930-5235 | 2005-06-30 |
| 1285003970 | Terrick Harrild | Physician Assistant | 75 Yellow Creek Rd, Suite 102, Evanston, WY 82930-5235 | 2015-09-23 |
| 1063794816 | Ronald Janeiro Dolan | Counselor | 75 Yellow Creek Rd, Suite 105, Evanston, WY 82930-5235 | 2011-09-16 |
| 1356621213 | Adrienne Southard | Nurse's Aide | 75 Yellow Creek Rd, 105, Evanston, WY 82930-5235 | 2011-08-24 |
| 1619257540 | Coreena J Bradley | Licensed Practical Nurse | 75 Yellow Creek Rd, Ste 105, Evanston, WY 82930-5235 | 2011-08-23 |
| 1346548088 | Alma D Coleman | Case Manager/Care Coordinator | 75 Yellow Creek Rd, Ste 105, Evanston, WY 82930-5235 | 2011-03-04 |
| 1235437989 | Renee C Walker | Nurse's Aide | 75 Yellow Creek Rd, Ste 105, Evanston, WY 82930-5235 | 2011-03-04 |
| 1205013455 | Michael D. Adams, M.d., P.C. | Family Medicine | 75 Yellow Creek Rd, Suite 102, Evanston, WY 82930-5235 | 2008-01-29 |
| 1023177375 | Uinta Urgent Care | Nurse Practitioner | 75 Yellow Creek Rd, Suite 202, Evanston, WY 82930 | 2006-12-06 |
| 1174563241 | Kimberly Anne Begalla | Nurse Practitioner | 75 Yellow Creek Rd, Suite 202, Evanston, WY 82930-5235 | 2006-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598398935 | Colby Kim Gomez | Physical Therapist | 190 Arrowhead Dr, Evanston, Wy 82930, Evanston, WY 82930 | 2020-02-13 |
| 1164808382 | Marilyn Carol Edgeworth Tacoma | Registered Nurse | 1037 Morse Lee St, Evanston, WY 82930 | 2015-08-11 |
| 1699159723 | Impact Physical Therapy LLC | Clinic/Center | 96 Yellow Creek Road, Evanston, WY 82930 | 2015-07-18 |
| 1578942421 | Mark Carstensen | Case Manager/Care Coordinator | 219 7th Street, Evanston, WY 82930 | 2015-05-26 |
| 1013396241 | Jennifer Carstensen | Case Manager/Care Coordinator | 325 Arrowhead Drive, Evanston, WY 82930 | 2015-05-20 |
| 1780083782 | Christa Lena Barker | Nurse Practitioner | 191 Overthrust Road, Evanston, WY 82930 | 2014-08-15 |
| 1366865339 | Don Mckay Francom | Dentist | 170 Arrowhead Dr. Suite 1, Evanston, WY 82930 | 2014-01-28 |
| 1417228370 | Premier Surgical Center, LLC | Clinic/Center | 195 Overthrust Road, Evanston, WY 82930 | 2012-01-24 |
| 1588959324 | Mejia D Williams | Social Worker | 190 Overthrust Road, Evanston, WY 82930 | 2011-06-09 |
| 1225327000 | Richard Jay Capener | Family Medicine | 196 Arrowhead Dr Ste 1, Evanston, WY 82930 | 2011-04-01 |
| Find all providers in zip 82930 | ||||
| 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 |
|---|---|---|---|---|
| 1194179721 | Access Community Health Network | Clinic/Center | 1723 Howard St, Evanston, IL 60202-3735 | 2016-04-20 |
| 1629328836 | Erie Family Health Center Inc | Clinic/Center | 1285 Hartrey, Evanston, IL 60202-1056 | 2012-09-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376004663 | Wind River Family & Community Health Care | Clinic/Center | 10266 Hwy 789, Arapahoe, WY 82510 | 2019-03-28 |
| 1447710843 | Wind River Family and Community Health Care | Clinic/Center | 510 Ethete Road, Ethete, WY 82520 | 2019-03-21 |
| 1538623665 | Powell Health Care Coalition | Clinic/Center | 444 Greybull Ave, Greybull, WY 82426-2037 | 2019-01-23 |
| 1366914889 | Community Health Center of Central Wyoming Inc | Clinic/Center | 704 Fremont Ave, Riverton, WY 82501 | 2018-12-21 |
| 1457823007 | Community Health Center of Central Wyoming Inc | Clinic/Center | 223 N Cherry St, Pavillion, WY 82523-5005 | 2018-12-20 |
| 1699292391 | Wind River Cares Riverton | Clinic/Center | 511 North 12 Street East, Riverton, WY 82501 | 2017-08-24 |
| 1558735308 | Montana Migrant and Seasonal Farmworkers Council, Inc. | Clinic/Center | 212 West 6th Street, Powell, WY 82435-1809 | 2015-11-17 |
| 1568846962 | Powell Health Care Coalition | Clinic/Center | 128 N. Bent St, Powell, WY 82435-2712 | 2015-07-15 |
| 1073953287 | Wyoming Health Council | Clinic/Center | 615 E 7th St, Powell, WY 82435-1643 | 2013-07-02 |
| 1275810160 | Community Health Center of Central Wyoming Inc | Clinic/Center | 2002 W. Sunset Dr., Suite 2, Riverton, WY 82501-2285 | 2011-11-07 |
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| 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.