LAKE SUPERIOR COMMUNITY HEALTH CENTER NPI 1639684384

NPI Information

NPI: 1639684384
Provider Name: LAKE SUPERIOR COMMUNITY HEALTH CENTER

Doing Business As: LAKE SUPERIOR COMMUNITY HEALTH CENTER

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

Specialization: Federally Qualified Health Center (FQHC)

Address:
1500 N 34TH ST STE 200
SUPERIOR, WI
ZIP 54880
Phone: (715) 395-5380
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LAKE SUPERIOR COMMUNITY HEALTH CENTER is a federally qualified health center (fqhc) clinic center in Superior, WI. LAKE SUPERIOR COMMUNITY HEALTH CENTER NPI is 1639684384. The provider is registered as an organization entity type.
The provider Is Doing Business As Lake Superior Community Health Center.

The provider's business location address is:

1500 N 34TH ST STE 200
SUPERIOR, WI
ZIP 54880-477
Phone: (715) 395-5380
Fax: (715) 394-2682

The provider's authorized official is Jessie Peterson .
The authorized official title is Coo and has the following contact phone number (218) 722-1497.

The enumeration date for this NPI number is 12/4/2017 and was last updated on 2/8/2021.

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

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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