NPIMap

Organization Active NPI

Shell Lake Clinic, LTD

  • Family Medicine Physician
  • Shell Lake, WI
National Provider Identifier
1083722805
Registry record updated Oct 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SHELL LAKE CLINIC, LTD
Practice address
105 4TH Ave
Shell Lake, WI 54871-0336
Phone
(715) 468-2711
Fax
(715) 468-2727
NPI assigned
Aug 29, 2006
Last updated
Oct 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jeffrey L Dunham, MD
Title
President
Phone
(715) 468-2711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

105 4TH Ave
Shell Lake, WI 54871-0336

Mailing address

105 4TH Ave
P O Box 336
Shell Lake, WI 54871-0336
Phone (715) 468-2711

Other identifiers 1

IdentifierTypeStateIssuer
32751100MedicaidWI

National Provider Directory

National Provider Directory

Locations

7728 Main St
Siren, WI 54872
Phone (715) 349-2910

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224720000000",
    "number": "1083722805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 4TH AVE",
            "address_2": "P O BOX 336",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "548710336",
            "telephone_number": "715-468-2711",
            "fax_number": "715-468-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 4TH AVE",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "548710336",
            "telephone_number": "715-468-2711",
            "fax_number": "715-468-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELL LAKE CLINIC, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2008-10-23",
        "status": "A",
        "authorized_official_last_name": "DUNHAM",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-468-2711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32751100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shell Lake, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.