National Provider Identifier Database

LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Federally Qualified Health Center (FQHC)

A Federally Qualified Health Center (FQHC) is a community-based organization that provides comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status.


Contact Information

LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
129 OLD ABE RD
LAC DU FLAMBEAU, WI54538-9386
Phone: 715-588-3371
Fax: 715-588-2031
Website:
Specialty Taxonomy Code
* Federally Qualified Health Center (FQHC) 261QF0400X
Case Management 251B00000X
Health Service 261QH0100X
Primary Care 261QP2300X

* Indicates primary specialty

NPI Profile & details for LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS

NPI Number 1134235047
Legal business name
LBN
LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Authorized official RANDY SAMUELSON - (ADMINISTRATOR)
Entity Organization
Organization subpart Yes
Enumeration date 08/22/2006
Last updated 09/03/2013 - About 13 years ago
Sole proprietor1 Not specified
Identifiers
  • WI Medicaid: 32956800
  • WI Medicaid: 41854400
  • WI Medicaid: 44004700

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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