NPIMap

Bad River Health and Wellness Center

Organization Active NPI Federally Qualified Health Center (FQHC) · Ashland, WI

NPI 1255682183 · NPPES record last updated Oct 2, 2012

Key facts

NPI
1255682183
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
BAD RIVER HEALTH AND WELLNESS CENTER
Practice address
53585 Nokomis Rd
Ashland, WI 54806-4272
Phone
(715) 682-7133
Fax
(715) 685-7857
NPI assigned
Oct 2, 2012
Organization subpart
Yes
Parent organization (as reported)
BAD RIVER BAND OF LAKE SUPERIOR CHIPPEWA INDIANS

Authorized official

Name
Mrs. Debra Ann Tutor
Title
Clinic Administrator
Phone
(715) 682-7133

Corporate family (same tax ID) 7

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

National Provider Directory

Tax ID family
Bad River Band of Lake Superior Tribe of Chippewa Indains Wis (8 organizations share this tax ID)
Part of
Bad River Band of Lake Superior Tribe of Chippewa Indains Wis

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

53585 Nokomis Rd
Ashland, WI 54806-4272

Mailing address

53585 Nokomis Rd
Ashland, WI 54806-4272
Phone (715) 682-7133

Other names

  • Bad River Dental Office Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 2, 2012.

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349136000000",
    "number": "1255682183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53585 NOKOMIS RD",
            "city": "ASHLAND",
            "state": "WI",
            "postal_code": "548064272",
            "telephone_number": "715-682-7133",
            "fax_number": "715-685-7857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53585 NOKOMIS RD",
            "city": "ASHLAND",
            "state": "WI",
            "postal_code": "548064272",
            "telephone_number": "715-682-7133",
            "fax_number": "715-685-7857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAD RIVER HEALTH AND WELLNESS CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAD RIVER BAND OF LAKE SUPERIOR CHIPPEWA INDIANS",
        "enumeration_date": "2012-10-02",
        "last_updated": "2012-10-02",
        "status": "A",
        "authorized_official_last_name": "TUTOR",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "715-682-7133",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bad River Dental Office",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ashland, WI

All providers in Ashland, WI · Federally Qualified Health Center (FQHC) in Wisconsin

Sources for this page

Verify at the official NPI Registry.