National Provider Identifier Database

BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS
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

BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS
53585 NOKOMIS ROAD
ASHLAND, WI54806-4272
Phone: 715-682-7133
Fax: 715-685-7857
Website:
Specialty Taxonomy Code
* Federally Qualified Health Center (FQHC) 261QF0400X
Clinic/Center 261Q00000X
Dentist 122300000X
Public Health or Welfare 251K00000X

* Indicates primary specialty

NPI Profile & details for BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS

NPI Number 1699701375
Legal business name
LBN
BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS
Authorized official DEBRA TUTOR - (CLINIC ADMINISTRATOR)
Entity Organization
Organization subpart Yes
Enumeration date 06/24/2006
Last updated 04/06/2016 - About 10 years ago
Sole proprietor1 Not specified
Identifiers
  • WI Medicaid: 32957600
  • WI Other: TRZ020 TRAILBLAZER/MEDICARE

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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