Organization
LAKE SUPERIOR COMMUNITY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATRINA JAWORSKI (DIRECTOR OF FINANCE)
(715) 392-1955
Entity
Organization
Contact information
Practice address
4325 GRAND AVE, DULUTH, MN 55807-2730
(218) 722-1497
(218) 727-8346
Mailing address
3600 TOWER AVE, SUPERIOR, WI 54880-5589
(715) 392-1955
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QP2300X
Primary Care Clinic/Center
R 228856-1
MN
Other
Enumeration date
10/07/2015
Last updated
08/26/2020
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