Organization
FOREST COUNTY POTAWATOMI COMMUNITY
Active
Other names
POTAWATOMI HEALTH & WELLNESS CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NED DANIELS (TRIBAL CHAIRMAN)
(715) 478-4824
Entity
Organization
Contact information
Practice address
8201 MISH KO SWEN DRIVE, CRANDON, WI 54520-8631
(715) 478-4300
(715) 478-4300
Mailing address
PO BOX 396, CRANDON, WI 54520-0396
(715) 478-4300
(715) 478-4490
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
—
—
133N00000X
Nutritionist
—
—
208000000X
Pediatrics Physician
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
WI
261QH0700X
Hearing and Speech Clinic/Center
—
—
261QP1100X
Podiatric Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
—
—
261QR0206X
Mammography Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
332S00000X
Hearing Aid Equipment
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32956600
—
WI
01
—
391235059016
BLUE CROSS BLUE SHIELD
WI
01
—
41752300
DURABLE MEDICAL EQUIPMENT
WI
05
—
41752300
—
WI
01
—
42182600
AODA CLINIC
WI
05
—
42182600
—
WI
01
—
44006100
PRENATAL CARE
WI
05
—
44006100
—
WI
01
—
DA0385
RAILROAD MEDICARE
WI
Enumeration date
08/24/2006
Last updated
12/09/2020
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