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Contact Information

LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
129 OLD ABE RD
LAC DU FLAMBEAU, WI54538
 Phone: 715-588-3371
 Fax: 715-588-2039
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

332800000X 87 All Other Suppliers
Indicates primary specialty

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

NPI Number 1447271408
LBN Legal business name LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Authorized official RANDY SAMUELSON - (ADMINISTRATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 07/22/2006
Last updated 02/27/2017 - About 9 years ago
Identifiers
WI License # 8933-042
WI Medicaid 32956800
Other 5122382 NCPDP PROVIDER IDENTIFICATION NUMBER
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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