NPIMap

Organization Active NPI

Red Cliff Band of Lake Superior Chippewa

  • Dentist
  • Bayfield, WI
National Provider Identifier
1215095641
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
RED CLIFF BAND OF LAKE SUPERIOR CHIPPEWA
Practice address
88385 Pike Rd
Bayfield, WI 54814-4818
Phone
(715) 779-3707
Fax
(715) 779-3777
NPI assigned
Dec 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Patricia A Deragon-Navarro
Title
Health Administrator
Phone
(715) 779-3707

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

88385 Pike Rd
Bayfield, WI 54814-4818

Mailing address

PO Box 529
Bayfield, WI 54814-0529
Phone (715) 779-4707

Other names 1

  • Red Cliff Community Health Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Red Cliff Trib Amb Ser9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215095641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 529",
            "city": "BAYFIELD",
            "state": "WI",
            "postal_code": "548140529",
            "telephone_number": "715-779-4707",
            "fax_number": "715-779-3777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88385 PIKE RD",
            "city": "BAYFIELD",
            "state": "WI",
            "postal_code": "548144818",
            "telephone_number": "715-779-3707",
            "fax_number": "715-779-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED CLIFF BAND OF LAKE SUPERIOR CHIPPEWA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DERAGON-NAVARRO",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "HEALTH ADMINISTRATOR",
        "authorized_official_telephone_number": "715-779-3707",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Red Cliff Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bayfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.