STOCKBRIDGE MUNSEE COMMUNITY NPI 1629070180

NPI Information

NPI: 1629070180
Provider Name: STOCKBRIDGE MUNSEE COMMUNITY
Classification: Clinic/Center - 261QF0400X
Specialization: Federally Qualified Health Center (FQHC)
Entity Type: Organization
:
CLIA Number: 52D0395391
Address: W12802 CTY RD A
BOWLER, WI
ZIP 54416
Phone: (715) 793-4144

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NPI Details

STOCKBRIDGE MUNSEE COMMUNITY is a federally qualified health center (fqhc) clinic center in Bowler, WI. STOCKBRIDGE MUNSEE COMMUNITY NPI is 1629070180. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

W12802 CTY RD A
BOWLER, WI
ZIP 54416
Phone: (715) 793-4144
Fax: (715) 793-5028

The provider's authorized official is Wallace A. Miller .
The authorized official title is Tribal Chairman and has the following contact phone number (715) 793-4111.

The CLIA number assigned to this NPI record is 52D0395391 - federally qualified health center with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 8/15/2005 and was last updated on 3/25/2025.

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
1	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	Other Provider Identifier Issuer
1	32955900	MEDICAID	WISCONSIN
2	41730300	MEDICAID	WISCONSIN
3	44008700	MEDICAID	WISCONSIN
4	39114544+040	OTHER	WISCONSIN	BLUE CROSS BLUE SHIELD
5	42125400	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: 11/21/2025

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