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Organization
RED CLIFF BAND OF :AKE SUPERIOR
Active
Organization
RED CLIFF BAND OF :AKE SUPERIOR
Active
Other names
RED CLIFF COMM HEALTH CENTER PHY
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD PETERSON (TRIBAL CHAIRMAN)
(715) 779-3700
Entity
Organization
Contact information
Practice address
36745 AIKEN RD, BAYFIELD, WI 54814-4579
(715) 779-3157
(715) 779-3501
Mailing address
36745 AIKEN RD, BAYFIELD, WI 54814-4579
(715) 779-3157
(715) 779-3752
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2108718
PK
—
05
—
32956200
—
WI
Enumeration date
11/15/2006
Last updated
07/19/2018
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