Active NPI
Lac Vieux Desert Band of Lake Superior Chippewa Indians
Doing business as LVD Health Center
- Federally Qualified Health Center (FQHC)
- Watersmeet, MI
National Provider Identifier
1114071578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- Legal business name
- LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
- Doing business as
- LVD Health Center
- Practice address
- N5241 US Highway 45
Watersmeet, MI 49969-0009 - Phone
- (906) 358-4588
- Fax
- (906) 358-4118
- NPI assigned
- Jan 23, 2007
- Last updated
- Sep 11, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- James Williams Jr.
- Title
- Lac Vieux Desert Tribal Chairman
- Phone
- (906) 358-4577
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | NU | ||
| Federally Qualified Health Center (FQHC) | 261QF0400X | NU | Primary |
Addresses
Primary practice location
N5241 US Highway 45
Watersmeet, MI 49969-0009
Mailing address
PO Box 9
Watersmeet, MI 49969-0009
Phone (906) 358-4588
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114071578 | Medicaid | MI | |
| OB74513 | Other | MI | BLUE CROSS BLUE SHIELD |
Other names 1
- LVD Health Center
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | medicalrecords@lvdhealthcenter.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI, TX
Enrollment records 3
National Provider Directory
National Provider DirectoryLocations
N5241 US Highway 45
Watersmeet, MI 49969
Phone (906) 358-4587
Practitioners & affiliated clinicians
Practitioners 27
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": "1169510400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1694390400000",
"number": "1114071578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9",
"city": "WATERSMEET",
"state": "MI",
"postal_code": "499690009",
"telephone_number": "906-358-4588",
"fax_number": "906-358-4118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N5241 US HIGHWAY 45",
"city": "WATERSMEET",
"state": "MI",
"postal_code": "499690009",
"telephone_number": "906-358-4588",
"fax_number": "906-358-4118"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-23",
"last_updated": "2023-09-11",
"certification_date": "2023-09-11",
"status": "A",
"authorized_official_last_name": "WILLIAMS",
"authorized_official_first_name": "JAMES",
"authorized_official_title_or_position": "LAC VIEUX DESERT TRIBAL CHAIRMAN",
"authorized_official_telephone_number": "906-358-4577",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QF0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1114071578",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "OB74513",
"state": "MI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "medicalrecords@lvdhealthcenter.com",
"affiliation": "N",
"endpointDescription": "Secure email",
"address_1": "N5241 US Highway 45",
"city": "Watersmeet",
"state": "MI",
"country_code": "US",
"postal_code": "499695115",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "LVD Health Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Watersmeet, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.