National Provider Identifier Database

RED CLIFF BAND OF AKE SUPERIOR
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603.


Contact Information

RED CLIFF BAND OF :AKE SUPERIOR
36745 AIKEN RD
BAYFIELD, WI54814-4579
Phone: 715-779-3157
Fax: 715-779-3501
Website:
Specialty Taxonomy Code
* Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X
Pharmacy 333600000X

* Indicates primary specialty

NPI Profile & details for RED CLIFF BAND OF :AKE SUPERIOR

NPI Number 1275606808
Legal business name
LBN
RED CLIFF BAND OF :AKE SUPERIOR
Authorized official RICHARD PETERSON - (TRIBAL CHAIRMAN)
Entity Organization
Organization subpart No
Enumeration date 11/15/2006
Last updated 07/19/2018 - About 8 years ago
Sole proprietor1 Not specified
Identifiers
  • WI Medicaid: 32956200
  • Other: 2108718 PK

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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