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SHELL LAKE CLINIC LTD NPI 1508225988


NPI Information

NPI: 1508225988
Provider Name: SHELL LAKE CLINIC, LTD
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 52D0662129

Address:
105 4TH AVE
SHELL LAKE, WI
ZIP 54871
Phone: (715) 468-2711
Get Directions

SHELL LAKE CLINIC, LTD is a family medicine in Shell Lake, WI. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. SHELL LAKE CLINIC, LTD NPI is 1508225988. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

105 4TH AVE
SHELL LAKE, WI
ZIP 54871-457
Phone: (715) 468-2711
Fax: (715) 468-2727

The provider's authorized official is Jeffrey L. Dunham .
The authorized official title is President and has the following contact phone number (715) 468-2711.

The CLIA number assigned to this NPI record is 52D0662129 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/15/2016 and was last updated on 2/15/2016.


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 License Number License State Primary
1207Q00000XFamily Medicine61281-20WISCONSINYes

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 Other Provider Identifier Issuer
11932141157MEDICAIDWISCONSIN
2660200027MEDICARE PINWISCONSIN

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.