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Organization
MENOMINEE INDIAN TRIBE OF WISCONSIN
Active
Organization
MENOMINEE INDIAN TRIBE OF WISCONSIN
Active
Other names
Menominee Tribal Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY L WAUKAU SR. (HEALTH ADMINISTRATOR)
(715) 799-3361
Entity
Organization
Contact information
Practice address
W3275 WOLF RIVER ROAD, KESHENA, WI 54135
(715) 799-3361
(715) 799-3099
Mailing address
PO BOX 970, KESHENA, WI 54135-0970
(715) 799-3361
(715) 799-3099
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32955700
—
WI
Enumeration date
06/12/2006
Last updated
04/02/2019
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