Organization
BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS
Active
Parent organization
BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS
Other names
Bad River Health and Wellness Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS
Authorized official
MRS. DEBRA ANN TUTOR (CLINIC ADMINISTRATOR)
(715) 682-7133
Entity
Organization
Contact information
Practice address
53585 NOKOMIS ROAD, ASHLAND, WI 54806-4272
(715) 682-7133
(715) 685-7857
Mailing address
53585 NOKOMIS ROAD, ASHLAND, WI 54806-4272
(715) 682-7133
(715) 685-7857
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
WI
251K00000X
Public Health or Welfare Agency
—
WI
261Q00000X
Clinic/Center
—
WI
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32957600
—
WI
01
—
TRZ020
TRAILBLAZER/MEDICARE
WI
Enumeration date
06/24/2006
Last updated
04/06/2016
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