Provider Demographics
NPI:1831386705
Name:BEAR LAKE PROFESSIONALS INC
Entity type:Organization
Organization Name:BEAR LAKE PROFESSIONALS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MGR
Authorized Official - Phone:661-713-9635
Mailing Address - Street 1:2312 RUSHLAND LANDING RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-8753
Mailing Address - Country:US
Mailing Address - Phone:661-433-6321
Mailing Address - Fax:909-878-3697
Practice Address - Street 1:2312 RUSHLAND LANDING RD
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-8753
Practice Address - Country:US
Practice Address - Phone:661-433-6321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care