Lake Superior Community Health Center

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

LAKE SUPERIOR COMMUNITY HEALTH CENTER

Doing business as

Lake Superior Community Health Center

Practice address

1500 N 34TH St Ste 200
Superior, WI 54880-4477

Phone

(715) 395-5380

Fax

(715) 394-2682

NPI assigned

Dec 4, 2017

Organization subpart

No

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

Authorized official

Name

Jessie Peterson

Title

Coo

Phone

(218) 722-1497

Specialties & licenses 1

Addresses

Other names 1

• Lake Superior Community Health Center Doing business as

Locations

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

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612742400000",
    "number": "1639684384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N 34TH ST",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548804477",
            "telephone_number": "715-395-5380",
            "fax_number": "715-394-2682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N 34TH ST STE 200",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548804477",
            "telephone_number": "715-395-5380",
            "fax_number": "715-394-2682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SUPERIOR COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-04",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "218-722-1497"
    },
    "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": "Lake Superior Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Superior Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Marie Laflamme, P.A.
• Kimberly Ann Laible, C.O.T.A.
• Lake Superior Chiropractic Office, S.C.
• Lake Superior Community Health Center
• Lake Superior Community Health Center
• James Sebastian Lane
• Ryan Michael Sahand Lane, MSW, LGSW
• Lange Chiropractic Centers, S.C.
• Michael Lao
• Brynn Larrabee, RN

• Federally Qualified Health Center (FQHC) in Superior, WI
• Providers in Superior, WI by specialty
• Federally Qualified Health Center (FQHC) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; 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.