| Bear Lake Community Health Center - Randolph | |
|
120 S Main St Randolph UT 84064-7701 | |
| (435) 755-6061 | |
| Not Available |
| Full Name | Bear Lake Community Health Center - Randolph |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 120 S Main St, Randolph, Utah |
| Authorized Official Name and Position | Jorge Garcia (CEO) |
| Authorized Official Contact | 4357556061 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bear Lake Community Health Center - Randolph 517 W 100 N Ste 210 Providence UT 84332-9826 Ph: (435) 755-6061 | Bear Lake Community Health Center - Randolph 120 S Main St Randolph UT 84064-7701 Ph: (435) 755-6061 |
| NPI Number | 1689241762 |
|---|---|
| Provider Enumeration Date | 06/08/2021 |
| Last Update Date | 04/27/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689241762 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |