Organization
LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Active
Organization
LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Active
Parent organization
LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Other names
Peter Christensen Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Authorized official
MR. RANDY SAMUELSON (ADMINISTRATOR)
(715) 588-3371
Entity
Organization
Contact information
Practice address
129 OLD ABE RD, LAC DU FLAMBEAU, WI 54538-9386
(715) 588-3371
(715) 588-2031
Mailing address
129 OLD ABE RD, LAC DU FLAMBEAU, WI 54538-9386
(715) 588-3371
(715) 588-2031
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32956800
—
WI
05
—
41854400
—
WI
05
—
44004700
—
WI
Enumeration date
08/22/2006
Last updated
09/03/2013
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