Organization
LAKE SUPERIOR COMMUNITY HEALTH CENTER
Active
Other names
Lake Superior Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE PETERSON (COO)
(218) 722-1497
Entity
Organization
Contact information
Practice address
1500 N 34TH ST STE 200, SUPERIOR, WI 54880-4477
(715) 395-5380
(715) 394-2682
Mailing address
1500 N 34TH ST, SUPERIOR, WI 54880-4477
(715) 395-5380
(715) 394-2682
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
12/04/2017
Last updated
02/08/2021
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