Provider Demographics
NPI:1609094507
Name:BEAR RIVER DISTRICT HEALTH DEPT
Entity Type:Organization
Organization Name:BEAR RIVER DISTRICT HEALTH DEPT
Other - Org Name:BEAR RIVER DISTRICT HEALTH DEPARTMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INSURANCE CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOREHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-792-6516
Mailing Address - Street 1:655 E 1300 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2570
Mailing Address - Country:US
Mailing Address - Phone:435-792-6500
Mailing Address - Fax:435-792-6600
Practice Address - Street 1:655 E 1300 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341
Practice Address - Country:US
Practice Address - Phone:435-792-6500
Practice Address - Fax:435-792-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT998877668007Medicaid
UT999000150000Medicaid
UT=========005Medicaid
UTX12376Medicare UPIN