LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS (NPI# 1134235047) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134235047 |
| Entity Type | Organization |
| Organization Name | LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS |
| Other Organization Name | PETER CHRISTENSEN HEALTH CENTER |
| Practice Address |
129 Old Abe Rd Lac Du Flambeau WI 54538-9386 |
| Practice Telephone | 7155883371 |
| Practice Fax Number | 7155882031 |
| Mailing Telephone | 7155883371 |
| Mailing Fax Number | 7155882031 |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2013-09-03 |
| Authorized Official Name | MR. RANDY SAMUELSON (ADMINISTRATOR) |
| Authorized Official Telephone | 7155883371 |
| Is Organization Subpart | Y |
| Parent Organization Name | LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QH0100X |
Clinic/Center Specialization: Health Service |
Ambulatory Health Care Facilities | ||
| N | 251B00000X | Case Management | Agencies | ||
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 32956800 | 05 | |
| WI | 44004700 | 05 | |
| WI | 41854400 | 05 |
| Other Name | Type Code |
|---|---|
| Peter Christensen Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669970729 | Lac Du Flambeau Band of Lake Superior Chippewa Indians | Clinic/Center | 3378 N. Schilleman Rd, Lac Du Flambeau, WI 54538-0815 | 2018-01-24 |
| 1861885014 | Lac Du Flambeau Band of Lake Superior Chippewa Indians | Community/Behavioral Health | 533 Peace Pipe Rd, Lac Du Flambeau, WI 54538-9123 | 2015-03-12 |
| 1427347426 | Lac Du Flambeau Band of Lake Superior Chippewa Indians | Clinic/Center | 128 Old Abe Rd, Lac Du Flambeau, WI 54538-9682 | 2011-03-31 |
| 1306016563 | Lac Du Flambeau Band of Lake Superior Chippewa Indians | Case Management | 533 Peace Pipe Road, Lac Du Flambeau, WI 54538-0189 | 2008-03-04 |
| 1447271408 | Lac Du Flambeau Band of Lake Superior Chippewa Indians | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 129 Old Abe Rd, Lac Du Flambeau, WI 54538 | 2006-07-22 |
| Street Address |
129 OLD ABE RD |
| City | LAC DU FLAMBEAU |
| State | WI |
| Zip Code | 54538-9386 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992795223 | Kenneth R Ninham | Counselor | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2005-10-27 |
| 1578175063 | Lucas C Daniels | Nurse Practitioner | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2020-08-18 |
| 1841801388 | Andrew Friedley | Pharmacist | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2020-08-10 |
| 1386255834 | Nicholis Ross Laporte | Pharmacist | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2020-08-10 |
| 1689145443 | Alissa R Martin | Social Worker | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2018-12-05 |
| 1831556901 | Katrina Angel Mares | Chiropractor | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2016-01-20 |
| 1831570761 | Shane Brahm | Optometrist | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2015-06-16 |
| 1447690375 | Emily E Busha | Physician Assistant | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2013-06-25 |
| 1770812505 | Scott C Kuehn | Counselor | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2009-12-07 |
| 1447271408 | Lac Du Flambeau Band of Lake Superior Chippewa Indians | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 129 Old Abe Rd, Lac Du Flambeau, WI 54538 | 2006-07-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265757256 | Stacey Dean | Registered Nurse | 8727 West Squaw Lake Road, Lac Du Flambeau, WI 54538 | 2010-04-01 |
| 1447398532 | Wendy Lindstrom | Counselor | 533 Peace Pipe Rd, Lac Du Flambeau, WI 54538 | 2007-02-02 |
| 1932295581 | Rick Lee Howe | Pharmacist | 450 Ols Abe Road, Lac Du Flambeau, WI 54538 | 2006-10-04 |
| 1902990534 | Timothy P. Obukowicz | Pharmacist | 450 Old Abe Road, Lac Du Flambeau, WI 54538 | 2006-10-03 |
| 1295849420 | Brian D Schafer | Pharmacist | 129 Old Abe Road, Lac Du Flambeau, WI 54538 | 2006-08-17 |
| 1720071723 | Town of Lac Du Flambeau | Ambulance | 614 Wild Rice Avenue, Lac Du Flambeau, WI 54538 | 2005-08-24 |
| 1508223066 | Amber Bickler | Dental Hygienist | 128 Old Abe Road, Lac Du Flambeau, WI 54538 | 2016-01-28 |
| 1689712770 | Linda M Daniels | Counselor | 533 Peace Pipe Rd, Lac Du Flambeau, WI 54538 | 2007-02-02 |
| 1477611432 | Gary Louis Gusmerotti | Dentist | 128 Old Abe Rd, Lac Du Flambeau, WI 54538-0128 | 2006-12-04 |
| 1073940136 | Sarah Jean Galloy | Dental Hygienist | 128 Old Abe Road, Lac Du Flambeau, WI 54538-0128 | 2013-10-03 |
| Find all providers in zip 54538 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669970729 | Lac Du Flambeau Band of Lake Superior Chippewa Indians | Clinic/Center | 3378 N. Schilleman Rd, Lac Du Flambeau, WI 54538-0815 | 2018-01-24 |
| 1427347426 | Lac Du Flambeau Band of Lake Superior Chippewa Indians | Clinic/Center | 128 Old Abe Rd, Lac Du Flambeau, WI 54538-9682 | 2011-03-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326693847 | Scenic Bluffs Health Center, Inc | Clinic/Center | 100 Blackhawk Dr, Viroqua, WI 54665-1315 | 2019-08-02 |
| 1942718762 | Sixteenth Street Community Health Centers, Inc. | Clinic/Center | 2607 S 5th St, Milwaukee, WI 53207-1418 | 2018-01-15 |
| 1659884716 | The Lakes Community Health Center, Inc | Clinic/Center | 15954 Rivers Edge Dr Ste 304, Hayward, WI 54843-7800 | 2017-11-13 |
| 1275056632 | Outreach Community Health Centers, Inc. | Clinic/Center | 9120 W Hampton Ave Ste 119, Milwaukee, WI 53225-4960 | 2017-07-18 |
| 1437695038 | Scenic Bluffs Health Center, Inc. | Clinic/Center | 200 West North Street, Norwalk, WI 54648 | 2017-01-06 |
| 1841742673 | The Lakes Community Health Center, Inc | Clinic/Center | 300 Main Street West, Ashland, WI 54806-3696 | 2016-10-27 |
| 1174071658 | Kenosha Community Health Center, Inc. | Clinic/Center | 2310 Center St, Racine, WI 53403-3330 | 2016-09-14 |
| 1841652021 | Scenic Bluffs Health Center, Inc. | Clinic/Center | 201 E Franklin St Rm B3, Sparta, WI 54656-1803 | 2016-03-25 |
| 1366844003 | Scenic Bluffs Health Center, Inc | Clinic/Center | 201 E Franklin St # B3, Sparta, WI 54656-1803 | 2014-09-25 |
| 1679983423 | The Lakes Community Health Center, Inc | Clinic/Center | 524 Bissell Street, White Lake, WI 54491 | 2014-05-02 |
| Find all providers with the same taxonomy | ||||
| City | LAC DU FLAMBEAU |
| Zip Code | 54538 |
Please comment or provide details below to improve the information on LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.