MENOMINEE INDIAN TRIBE OF WISCONSIN; NPI #1972545010

Contact Information

MENOMINEE INDIAN TRIBE OF WISCONSIN

W3275 WOLF RIVER ROAD
KESHENA, WI 54135

Phone: 715-799-3361
Fax: 715-799-3099
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Clinic Pharmacy	3336C0002X	58	Medical Supply Company with Pharmacist

Indicates primary specialty

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NPI Profile & details for MENOMINEE INDIAN TRIBE OF WISCONSIN

NPI Number 1972545010

LBN Legal business name MENOMINEE INDIAN TRIBE OF WISCONSIN

Authorized official JERRY WAUKAU - (HEALTH ADMINISTRATOR)

Entity Organization

Organization subpart ¹ No

Enumeration date 06/12/2006

Last updated 03/07/2023 - About 3 years ago

Identifiers

WI	License #	7848-042
WI	Medicaid	32955700
	Other	5118446	NAPB #

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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MENOMINEE INDIAN TRIBE OF WISCONSIN

Contact Information

Specialty

Clinic Pharmacy

NPI Profile & details for MENOMINEE INDIAN TRIBE OF WISCONSIN

Reviews for MENOMINEE INDIAN TRIBE OF WISCONSIN