Indianhead Medical Center Shell Lake Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

INDIANHEAD MEDICAL CENTER SHELL LAKE INC

Doing business as

Stone Lake Rural Health Clinic

Practice address

113 4TH Avenue
Shell Lake, WI 54871

Phone

(715) 468-7833

NPI assigned

Feb 13, 2007

Last updated

Jan 15, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Harold A McBee

Title

Owner

Phone

(410) 643-3393

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• STONE LAKE RURAL HEALTH CLINIC Doing business as

Interoperability endpoints

• FHIR API: https://fhir-usa.unify.chbase.com/org/indian-67995047

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452816000000",
    "number": "1356483796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16887 2ND ST S",
            "city": "STONE LAKE",
            "state": "WI",
            "postal_code": "548768938",
            "telephone_number": "715-468-7833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 4TH AVENUE",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "54871",
            "telephone_number": "715-468-7833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANHEAD MEDICAL CENTER SHELL LAKE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2016-01-15",
        "status": "A",
        "authorized_official_last_name": "MCBEE",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-643-3393"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43062300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STONE LAKE RURAL HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karissa Halvorson, COTA
• Lance Fay Haseltine, M.D.
• Hearts of Gold, Inc
• Delores Henderson-Olson, BS
• Danette Ellen Hopke, RN
• Indianhead Medical Center Shell Lake Inc
• Indianhead Medical Center Shell Lake Inc
• Indianhead Medical Center Shell Lake, Inc
• Indianhead Medical Center Shell Lake, Inc. (Indianhead Medical Center)
• Steven Michael Jacobson

• Rural Health Clinic/Center in Shell Lake, WI
• Providers in Shell Lake, WI by specialty
• Rural Health Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; 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.