Indianhead Medical Center Shell Lake Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

324 Issued in WI

Legal business name

INDIANHEAD MEDICAL CENTER SHELL LAKE INC

Practice address

113 Fourth Ave
Shell Lake, WI 54871

Phone

(715) 468-7833

NPI assigned

Feb 13, 2007

Last updated

Jan 14, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

INDIANHEAD MEDICAL CENTER SHELL LAKE INCAs reported in NPPES

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

Authorized official

Name

Mrs. Doris Jean Laursen, RN

Title

Administrator

Phone

(715) 468-7833

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Indianhead Med Ctr

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452729600000",
    "number": "1629110077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 FOURTH AVE",
            "address_2": "P.O. BOX 300",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "54871",
            "telephone_number": "715-468-7833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 FOURTH AVE",
            "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": "YES",
        "parent_organization_legal_business_name": "INDIANHEAD MEDICAL CENTER SHELL LAKE INC",
        "enumeration_date": "2007-02-13",
        "last_updated": "2016-01-14",
        "status": "A",
        "authorized_official_last_name": "LAURSEN",
        "authorized_official_first_name": "DORIS",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "715-468-7833",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "WI",
            "license": "324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41533400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lance Fay Haseltine, M.D.
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• Danette Ellen Hopke, RN
• Indianhead Medical Center Shell Lake Inc (Stone Lake Rural Health Clinic)
• Indianhead Medical Center Shell Lake Inc
• Indianhead Medical Center Shell Lake, Inc
• Indianhead Medical Center Shell Lake, Inc. (Indianhead Medical Center)
• Steven Michael Jacobson
• Keith M Jaglinski, P.T.A

• Home Health Agency in Shell Lake, WI
• Providers in Shell Lake, WI by specialty
• Home Health Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.