MEDICARE: BEAR MOUNTAIN MEDICAL SERVICES, A MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1316352867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAR MOUNTAIN MEDICAL SERVICES, A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	13737 NOEL RD STE 1600
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-1374
Country	:	US
Telephone Number	:	973-251-1132
Fax Number	:	214-712-2444

Provider Business Practice Location Address
First Line	:	41870 GARSTIN DRIVE
Second Line	:
City	:	BIG BEAR LAKE
State	:	CA
Zip	:	92315
Country	:	US
Telephone Number	:	973-251-1132
Fax Number	:

Authorized Official
Title or Position	:	VP PROVIDER ENROLLMENT
Name	:	KAREN VAUGHN
Credential	:
Telephone Number	:	215-678-5199

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	04/17/2026

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