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Contact Information

RED CLIFF BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
36745 AIKEN RD
BAYFIELD, WI54814-4579
 Phone: 715-779-3707
 Fax: 715-779-3362
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Federally Qualified Health Center (FQHC)

261QF0400X B4[14] Federally Qualified Health Center
 

Addiction (Substance Use Disorder)

101YA0400X
 

Ambulance

341600000X 59 Ambulance Service Provider
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Dental

261QD0000X
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Pharmacist

183500000X
 

Primary Care

261QP2300X
 

Registered Nurse

163W00000X
Indicates primary specialty

NPI Profile & details for RED CLIFF BAND OF LAKE SUPERIOR CHIPPEWA INDIANS

NPI # 1497744015
LBN Legal business name RED CLIFF BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Authorized official DIANE ERICKSON - (HEALTH SERVICES ADMINISTRATOR)
Entity Organization
Organization subpart 1 Yes
Enumeration date 10/17/2005
Last updated 02/24/2023 - About 3 years ago
Identifiers
WI License # 32956200
WI Medicaid 32956200
WI Medicaid 44004200
Other 10170-001 GROUP PLAN # DENTAL
Other CS3144 RR RETIREMENT PALMETTO
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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