NPIMap

Organization Active NPI

Menominee Indian Tribe of Wisconsin

Doing business as Menominee Tribal Clinic-Women's Personal Health

  • Non-Surgical Family Planning Clinic/Center
  • Keshena, WI
National Provider Identifier
1164618088
Registry record updated Mar 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Surgical Family Planning Clinic/CenterTaxonomy code 261QF0050X
License
93107-030 Issued in WI
Legal business name
MENOMINEE INDIAN TRIBE OF WISCONSIN
Doing business as
Menominee Tribal Clinic-Women's Personal Health
Practice address
W3275 Wolf River Road
Keshena, WI 54135
Phone
(715) 799-3361
Fax
(715) 799-3099
NPI assigned
Sep 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2009

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

Authorized official

Name
Jerry L Waukau Sr.
Title
Health Administrator
Phone
(715) 799-3361

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Surgical Family Planning Clinic/Center 261QF0050X 93107-030 WI Primary

Addresses

Primary practice location

W3275 Wolf River Road
Keshena, WI 54135

Mailing address

PO Box 970
Keshena, WI 54135-0970
Phone (715) 799-3361

Other identifiers 1

IdentifierTypeStateIssuer
42010500MedicaidWI

Other names 1

  • Menominee Tribal Clinic-Women's Personal Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Menominee Tribl Res SQ7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236729600000",
    "number": "1164618088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970",
            "city": "KESHENA",
            "state": "WI",
            "postal_code": "541350970",
            "telephone_number": "715-799-3361",
            "fax_number": "715-799-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W3275 WOLF RIVER ROAD",
            "city": "KESHENA",
            "state": "WI",
            "postal_code": "54135",
            "telephone_number": "715-799-3361",
            "fax_number": "715-799-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENOMINEE INDIAN TRIBE OF WISCONSIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2009-03-11",
        "status": "A",
        "authorized_official_last_name": "WAUKAU",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "HEALTH ADMINISTRATOR",
        "authorized_official_telephone_number": "715-799-3361",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": "WI",
            "license": "93107-030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42010500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Menominee Tribal Clinic-Women's Personal Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Keshena, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2009; 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.