Bad River Band of Lake Superior Tribe of Chippewa Indians Wis

NPI #1699701375 in Ashland, Wisconsin

Provider Information

NPI Number
1699701375
Entity Type
Organization
Organization Name
Bad River Band of Lake Superior Tribe of Chippewa Indians Wis
Subpart
Yes (part of a larger organization)
Parent Organization
BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS
Primary Specialty
Clinic/Center - Federally Qualified Health Center (FQHC)
Enumeration Date
Jun 24, 2006
Last Updated
Apr 6, 2016

Practice Location

Address
53585 NOKOMIS ROAD
ZIP Code
54806-4272
Phone
(715) 682-7133

Authorized Official

Name
MRS. DEBRA ANN TUTOR
Title
CLINIC ADMINISTRATOR
Phone
(715) 682-7133

Specialties & Taxonomy Codes

Specialty
Clinic/Center
Public Health or Welfare
Dentist
Clinic/Center - Federally Qualified Health Center (FQHC)Federally Qualified Health Center (FQHC)

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