Lac Du Flambeau Band of Lake Superior Chippewa Indians
NPI #1134235047 in Lac Du Flambeau, Wisconsin
Provider Information
- NPI Number
- 1134235047
- Entity Type
- Organization
- Organization Name
- Lac Du Flambeau Band of Lake Superior Chippewa Indians
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
- Primary Specialty
- Clinic/Center - Federally Qualified Health Center (FQHC)
- Enumeration Date
- Aug 22, 2006
- Last Updated
- Sep 3, 2013
Practice Location
- Address
- 129 OLD ABE RD
- City
- Lac Du Flambeau
- State
- Wisconsin
- ZIP Code
- 54538-9386
- Phone
- (715) 588-3371
Authorized Official
- Name
- MR. RANDY SAMUELSON
- Title
- ADMINISTRATOR
- Phone
- (715) 588-3371
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Health Service — Health Service |
| Case Management |
| Clinic/Center - Primary Care — Primary Care |
| Clinic/Center - Federally Qualified Health Center (FQHC) — Federally Qualified Health Center (FQHC) |
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