Organization
LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Active
Other names
LVD Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES WILLIAMS JR. (LAC VIEUX DESERT TRIBAL CHAIRMAN)
(906) 358-4577
Entity
Organization
Contact information
Practice address
N5241 US HIGHWAY 45, WATERSMEET, MI 49969-0009
(906) 358-4588
(906) 358-4118
Mailing address
PO BOX 9, WATERSMEET, MI 49969-0009
(906) 358-4588
(906) 358-4118
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114071578
—
MI
01
—
OB74513
BLUE CROSS BLUE SHIELD
MI
Enumeration date
01/23/2007
Last updated
09/11/2023
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