LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS NPI 1134235047

NPI Information

NPI: 1134235047
Provider Name: LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS

Doing Business As: PETER CHRISTENSEN HEALTH CENTER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
129 OLD ABE RD
LAC DU FLAMBEAU, WI
ZIP 54538
Phone: (715) 588-3371
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LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS is a federally qualified health center (fqhc) clinic center in Lac Du Flambeau, WI. LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS NPI is 1134235047. The provider is registered as an organization entity type.
The provider Is Doing Business As Peter Christensen Health Center.

The provider's business location address is:

129 OLD ABE RD
LAC DU FLAMBEAU, WI
ZIP 54538-386
Phone: (715) 588-3371
Fax: (715) 588-2031

The provider's authorized official is Randy Samuelson .
The authorized official title is Administrator and has the following contact phone number (715) 588-3371.

The enumeration date for this NPI number is 8/22/2006 and was last updated on 9/3/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	261QH0100X	Clinic/Center	Health Service	No
2	251B00000X	Case Management		No
3	261QP2300X	Clinic/Center	Primary Care	No
4	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	32956800	MEDICAID	WISCONSIN
2	41854400	MEDICAID	WISCONSIN
3	000064013	MEDICARE PIN	WISCONSIN
4	44004700	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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