LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS; NPI #1134235047

Contact Information

LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS

129 OLD ABE RD
LAC DU FLAMBEAU, WI 54538-9386

Phone: 715-588-3371
Fax: 715-588-2031
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Federally Qualified Health Center (FQHC)	261QF0400X	B4[14]	Federally Qualified Health Center
Case Management	251B00000X
Health Service	261QH0100X
Primary Care	261QP2300X

Indicates primary specialty

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

NPI Number 1134235047

LBN Legal business name LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS

Authorized official RANDY SAMUELSON - (ADMINISTRATOR)

Entity Organization

Organization subpart ¹ Yes

Enumeration date 08/22/2006

Last updated 09/03/2013 - About 13 years ago

Identifiers

WI	Medicaid	32956800
WI	Medicaid	41854400
WI	Medicaid	44004700

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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