Bad River Band of Lake Superior Tribe of Chippewa Indians Wis.
Organization Active NPI Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy · Ashland, WI
NPI 1780702829 · NPPES record last updated Jun 3, 2024
Key facts
- NPI
- 1780702829
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X
- Legal business name
- BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS.
- Practice address
- 53585 Nokomis Road
Ashland, WI 54806-4272 - Phone
- (715) 682-7133
- Fax
- (715) 685-8810
- NPI assigned
- Mar 27, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS.
Authorized official
- Name
- June Louise Williams
- Title
- Billing/PRC Manager
- Phone
- (715) 682-7133
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Practitioners 42
-
Pamela M Hayward, NP
-
Matthew John Horning, M.D.
-
Kristie Johnson, MD
-
Tammie S Jonas-Marsland, FNP-C
-
David C Larsen, DPM
-
Ashley Levra, PMHNP-BC
-
Shannon S Meyer, DPM
-
Alexander Anton Provost, D.C.
-
Alison Spaude-Filipczak, CAPSW
-
Arif Iqbal, O.D.
-
Pamela Joy Webber, FNP
-
James Everett Dunn, M.D.
-
Eileen S Gavin, M.D.
-
Sharon Handy, M.D.
-
Michael Saul Lundin, M.D.
-
Avari Miller, DC
-
Carrie Kay Bowman, P-MHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080808000523 | TX | Part B Supplier - Pharmacy | 7810089414 |
1 other NPI on this enrollment Practice locations: Ashland, WI |
National Provider Directory
- Part of
- Bad River Band of Lake Superior Tribe of Chippewa Indains Wis
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 332800000X | Yes |
Addresses
Primary practice location
53585 Nokomis Road
Ashland, WI 54806-4272
Mailing address
53585 Nokomis Road
Ashland, WI 54806-4272
Phone (715) 682-8518
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32787800 | Medicaid | WI |
Other names
- Bad River Clinic Pharmacy
Other providers in Ashland, WI
- Avanti Home Health Services, LLC
- Bad River Band of Lake Superior Tribe of Chippewa Indains Wis
- Bad River Band of Lake Superior Tribe of Chippewa Indians
- Bad River Band of Lake Superior Tribe of Chippewa Indians Wis
- Bad River Band of Lake Superior Tribe of Chippewa Indians Wis.
- Bad River Health and Wellness Center
- Bad River Honoring Our Children
- Krishna Raj Bagale
- Robert Bailen
- Rebecca B Bakker
All providers in Ashland, WI · Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.