BEAR LAKE COMMUNITY HEALTH CENTER (NPI# 1861949679) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1861949679 |
Entity Type | Organization |
Organization Name | BEAR LAKE COMMUNITY HEALTH CENTER |
Other Organization Name | BEAR LAKE COMMUNITY HEALTH CENTER - MONTPELIER |
Practice Address |
152 S 4th St Montpelier ID 83254-1538 |
Mailing Address |
1047 S 100 W Ste 270 Logan UT 84321-6790 |
Practice Telephone | 2089043600 |
Practice Fax Number | 2089040556 |
Mailing Telephone | 4357558424 |
Mailing Fax Number | 4357558436 |
Enumeration Date | 2016-09-09 |
Last Update Date | 2017-04-13 |
Authorized Official Name | MELISSA DUCE (PHARMACY OFFICE MANAGER) |
Authorized Official Telephone | 4357558424 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 333600000X | Pharmacy | Suppliers | ||
N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
44396RP | ID | Suppliers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
ID | 1861949679 | 05 | |
PK | 2167754 | 01 |
Other Name | Type Code |
---|---|
Bear Lake Community Health Center - Montpelier | Doing Business As Name - Organization |
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 |
1689754475 | Bear Lake Community Health Center | Clinic/Center | 325 W. Logan Hwy, Garden City, UT 84028-0328 | 2006-10-16 |
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 |
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 |
152 S 4TH ST |
City | MONTPELIER |
State | ID |
Zip Code | 83254-1538 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1932200391 | Heidi Yvonne Walker | Physician Assistant | 152 S 4th St, Montpelier, ID 83254-1538 | 2006-09-26 |
1033603345 | Sydnie M Hobbs | Nurse Practitioner | 152 S 4th St, Montpelier, ID 83254 | 2018-06-20 |
1184163511 | Bear Lake Community Health Center Pharmacy - 340b | Pharmacy | 152 S 4th St, Montpelier, ID 83254-1538 | 2017-02-17 |
1003264664 | Bear Lake Community Health Center | Clinic/Center | 152 S 4th St, Montpelier, ID 83254-1538 | 2016-05-24 |
1336512714 | Mark Berning | Pharmacist | 152 S 4th St, Montpelier, ID 83254-1538 | 2015-11-05 |
1386829687 | Mina L Wayman | Nurse Practitioner | 152 S 4th St, Montpelier, ID 83254-1538 | 2008-01-04 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1366597866 | Joseph F Decker Professional Corp | Surgery | 164 S 5th, Montpelier, ID 83254 | 2007-01-24 |
1447311139 | Bear Lake County | Ambulance | 385 Cemetary Road, Montpelier, ID 83254 | 2006-12-13 |
1073685343 | Steven D Hammond | Dentist | 455 Washington St, Montpelier, ID 83254 | 2006-11-14 |
1982610549 | Dorian S Grunig | Nurse Anesthetist, Certified Registered | 164 South 5th, Montpelier, ID 83254 | 2006-08-01 |
1104840412 | Harold A Olson | Pharmacist | 765 Washington St., Montpelier, ID 83254 | 2006-07-27 |
1265505705 | Robert D Degnan | Obstetrics & Gynecology | 742 Washington St, Montpelier, ID 83254 | 2006-11-15 |
1952491714 | Gary Scott Griffin | Nurse Anesthetist, Certified Registered | 164 South 5th, Montpelier, ID 83254 | 2006-10-13 |
1013027952 | Matthew Brinton Stevens | Chiropractor | 710 N 4th St, Montpelier, ID 83254-1050 | 2006-08-30 |
1265542435 | Reset P.a. | Chiropractor | 710 N 4th St, Montpelier, ID 83254-1050 | 2006-08-30 |
1740598614 | Bear Lake Memorial Hospital | Assisted Living Facility | 855 Boise St, Montpelier, ID 83254-1070 | 2010-09-14 |
Find all providers in zip 83254 |
Taxonomy Code | 3336C0002X |
Grouping | Suppliers |
Classification | Pharmacy |
Specialization | Clinic Pharmacy |
A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1184163511 | Bear Lake Community Health Center Pharmacy - 340b | Pharmacy | 152 S 4th St, Montpelier, ID 83254-1538 | 2017-02-17 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1164035689 | Allergy Butler, LLC | Pharmacy | 1611 12th Ave Rd Ste A, Nampa, ID 83686-6182 | 2020-08-25 |
1922312842 | Teton Valley Hospital Pharmacy | Pharmacy | 120 East Howard Ave., Driggs, ID 83422-5112 | 2010-08-03 |
1730351081 | Idaho State University | Pharmacy | 990 South 8th, Pocatello, ID 83209 | 2008-03-27 |
1740717693 | Snake River Pharmacy | Pharmacy | 4750 Yellowstone Ave, Chubbuck, ID 83202-2336 | 2017-05-22 |
1942615828 | Family Health Services Pharmacy | Pharmacy | 388 Martin Street, Family Health Services Pharmacy, Twin Falls, ID 83301-6856 | 2014-06-30 |
1669616272 | Community Health Clinics, Inc. | Pharmacy | 300 S 23rd St, Boise, ID 83702-9100 | 2009-04-27 |
1316156482 | Community Health Clinics, Inc. | Pharmacy | 802 Cleveland Blvd, Caldwell, ID 83605 | 2007-05-22 |
1770687188 | Community Health Clinics, Inc | Pharmacy | 223 16th Ave N, Nampa, ID 83687-4058 | 2006-09-08 |
City | MONTPELIER |
Zip Code | 83254 |
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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.