Lac Vieux Desert Band of Lake Superior Chippewa Indians

Primary specialty

Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X

Legal business name

LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS

Doing business as

Lac Vieux Desert Health Center and Pharmacy

Practice address

N5241 US Highway 45
Watersmeet, MI 49969-5115

Phone

(906) 358-4905

Fax

(906) 358-4929

NPI assigned

Jan 23, 2007

Organization subpart

No

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

Authorized official

Name

Sadie Valliere

Title

Health Director

Phone

(906) 358-4587

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Lac Vieux Desert Health Center and Pharmacy Doing business as

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621296000000",
    "number": "1760536007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N5241 US HIGHWAY 45",
            "city": "WATERSMEET",
            "state": "MI",
            "postal_code": "499695115",
            "telephone_number": "906-358-4905",
            "fax_number": "906-358-4929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N5241 US HIGHWAY 45",
            "city": "WATERSMEET",
            "state": "MI",
            "postal_code": "499695115",
            "telephone_number": "906-358-4905",
            "fax_number": "906-358-4929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A",
        "authorized_official_last_name": "VALLIERE",
        "authorized_official_first_name": "SADIE",
        "authorized_official_title_or_position": "HEALTH DIRECTOR",
        "authorized_official_telephone_number": "906-358-4587"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MI",
            "license": "5301006253",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33205200",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2354455",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lac Vieux Desert Health Center and Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kim Ivey, RPH
• Charissa Ann Jeske-Mahler, LMSW
• Kevin Michael Johnson, FNP
• Lucas A Kunze, MPT
• Lac Vieux Desert Band of Lake Superior Chippewa Indians (LVD Health Center)
• Rebecca Larson, DDS
• Adrienne Laverdure, MD
• Nubqub Lee
• Lisa Meza, P.A.-C
• Patti M Paige, FNP

• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Watersmeet, MI
• Providers in Watersmeet, MI by specialty
• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 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.