# BEAR LAKE COUNTY MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bear Lake Family Care and OB/GYN
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811138910
- **Authorized official:** JILL RASMUSSEN (PFS ASSISSTANT)
- **Authorized official phone:** (208) 847-4378

## Contact information

- **Practice address:** 465 WASHINGTON ST, MONTPELIER, ID 83254-1544
- **Practice address phone:** (208) 847-4495
- **Mailing address:** 164 S 5TH ST, MONTPELIER, ID 83254-1557
- **Mailing address phone:** (208) 847-1630
- **Mailing address fax:** (208) 847-2221

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/19/2009
- **Last updated:** 10/17/2016