BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS NPI 1699701375

NPI Information

NPI: 1699701375
Provider Name: BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS

Former Legal Business Name: BAD RIVER HEALTH AND WELLNESS CENTER

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

Specialization: Federally Qualified Health Center (FQHC)

Address:
53585 NOKOMIS ROAD
ASHLAND, WI
ZIP 54806
Phone: (715) 682-7133
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BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS is a federally qualified health center (fqhc) clinic center in Ashland, WI. BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS NPI is 1699701375. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Bad River Health And Wellness Center.

The provider's business location address is:

53585 NOKOMIS ROAD
ASHLAND, WI
ZIP 54806-272
Phone: (715) 682-7133
Fax: (715) 685-7857

The provider's authorized official is Debra Ann Tutor .
The authorized official title is Clinic Administrator and has the following contact phone number (715) 682-7133.

The enumeration date for this NPI number is 6/24/2006 and was last updated on 4/6/2016.

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 State	Primary
1	251K00000X	Public Health or Welfare		WISCONSIN	No
2	122300000X	Dentist		WISCONSIN	No
3	261Q00000X	Clinic/Center		WISCONSIN	No
4	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	WISCONSIN	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	TRZ020	OTHER	WISCONSIN	TRAILBLAZER/MEDICARE
2	521813	MEDICARE OSCAR/CERTIFICATION	WISCONSIN
3	521813	MEDICARE PIN	WISCONSIN
4	32957600	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: 11/14/2023

NPI Synchronization or Removal

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