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Organization
LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Active
Organization
LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Active
Other names
PETER CHRISTENSEN HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY SAMUELSON (ADMINISTRATOR)
(715) 588-3371
Entity
Organization
Contact information
Practice address
129 OLD ABE RD, LAC DU FLAMBEAU, WI 54538
(715) 588-3371
(715) 588-2039
Mailing address
129 OLD ABE RD, LAC DU FLAMBEAU, WI 54538
(715) 588-3371
(715) 588-2039
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
8933-042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32956800
—
WI
01
—
5122382
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/22/2006
Last updated
02/27/2017
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