The Lakes Community Health Center, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Minong, WI
NPI 1083961163 · NPPES record last updated Aug 5, 2021
Key facts
- NPI
- 1083961163
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 26972 (WI)
- Legal business name
- THE LAKES COMMUNITY HEALTH CENTER, INC
- Practice address
- 600 W Shell Creek Rd
Minong, WI 54859-9302 - Phone
- (715) 466-2201
- Fax
- (715) 466-2205
- NPI assigned
- Aug 8, 2012
- Organization subpart
- No
Authorized official
- Name
- Reba Rice
- Title
- Ceo
- Phone
- (715) 372-5001
Other NPIs on the same Medicare enrollment 17
Corporate family (same tax ID) 19
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101019000186 | WI | Part B Supplier - Clinic/Group Practice | 0840366654 |
Receives reassigned benefits from 119 practitioners 17 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: White Lake, WI; Washburn, WI; Turtle Lake, WI; Solon Springs, WI; Eau Claire, WI; Rice Lake, WI; Poplar, WI; Park Falls, WI… |
National Provider Directory
- Tax ID family
- The Lakes Community Health Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 26972 | WI | Yes |
Addresses
Primary practice location
600 W Shell Creek Rd
Minong, WI 54859-9302
Mailing address
15735 W US Highway 63
Hayward, WI 54843-6475
Phone (715) 934-0710
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811178825 | Medicaid | WI |
Other names
- Northlakes Community Clinic
Other providers in Minong, WI
- Frederick D Kosmach
- Minong Area Fire and Ambulance Service
- Northwood School District
- Heather L Runge
- Richard R Scott Jr.
- The Lakes Community Health Center, Inc
- The Lakes Community Health Center, Inc
- Dodson W Thompson
- Paul David Workman
All providers in Minong, WI · Federally Qualified Health Center (FQHC) in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.