Organization · Type 2 NPI

Bear Lake Community Health Center, Inc.

Federally Qualified Health Center (FQHC) · Evanston, WY

NPI number 1235495771 Active

Practice location

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

Call (307) 789-8290 Map

Fax (307) 789-8975

Mailing address

517 W 100 N Ste 210
Providence, UT 84332-9826

Specialties and licenses

Taxonomy	Code	License
Federally Qualified Health Center (FQHC) Primary	261QF0400X	None listed

Federally Qualified Health Center (FQHC): Definition to come...

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NPI record

NPI: 1235495771
Entity type: Organization (Type 2)
Issued: Apr 10, 2012
Last updated: Jun 1, 2022
Status: Active

Other names

<unavail>
Evanston Community Health Center · doing business as
Evanston Community Health Center · doing business as

Authorized official

Jorge Garcia
CEO
(435) 755-6061

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1235495771

Bear Lake Community Health Center, Inc.'s National Provider Identifier is 1235495771, issued on Apr 10, 2012. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Evanston, WY. The record was last updated on Jun 1, 2022.