Organization
INDIANHEAD MEDICAL CENTER SHELL LAKE, INC.
Active
Other names
Indianhead Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON JAMES JACK (EXECUTIVE VICE PRESIDENT)
(715) 468-7833
Entity
Organization
Contact information
Practice address
113 4TH AVE, SHELL LAKE, WI 54871-4457
(715) 468-7833
(715) 468-7303
Mailing address
PO BOX 300, SHELL LAKE, WI 54871-0300
(715) 468-7833
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11020700
—
WI
Enumeration date
09/06/2017
Last updated
03/09/2020
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