Active NPI
Forest County Potawatomi Health & Wellness
- Durable Medical Equipment & Medical Supplies
- Crandon, WI
National Provider Identifier
1801036447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Legal business name
- FOREST COUNTY POTAWATOMI HEALTH & WELLNESS
- Practice address
- 8201 Mishkoswen Dr
Crandon, WI 54520-0396 - Phone
- (715) 478-4300
- Fax
- (715) 478-4490
- NPI assigned
- Feb 23, 2009
- Last updated
- Dec 10, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Ned Daniels
- Title
- Tribal Chairman
- Phone
- (715) 478-4824
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | Primary |
Addresses
Primary practice location
8201 Mishkoswen Dr
Crandon, WI 54520-0396
Mailing address
PO Box 396
Crandon, WI 54520-0396
Phone (715) 478-4300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41752300 | Medicaid | WI |
National Provider Directory
National Provider Directory- Tax ID family
- Forest Co Potawatomi Co
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Crandon, WI
- NPI 1376650499
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235347200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1607558400000",
"number": "1801036447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 396",
"city": "CRANDON",
"state": "WI",
"postal_code": "545200396",
"telephone_number": "715-478-4300",
"fax_number": "715-478-4490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8201 MISHKOSWEN DR",
"city": "CRANDON",
"state": "WI",
"postal_code": "545200396",
"telephone_number": "715-478-4300",
"fax_number": "715-478-4490"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FOREST COUNTY POTAWATOMI HEALTH & WELLNESS",
"organizational_subpart": "NO",
"enumeration_date": "2009-02-23",
"last_updated": "2020-12-10",
"certification_date": "2020-12-09",
"status": "A",
"authorized_official_last_name": "DANIELS",
"authorized_official_first_name": "NED",
"authorized_official_title_or_position": "TRIBAL CHAIRMAN",
"authorized_official_telephone_number": "715-478-4824",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41752300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Crandon, WI
- Laura Donatelle, DNP APRN FNP
- Tanya Ann Doyle, LPCC
- Tracy Lynne Ferraro-Schumacher, MSW
- Forest County Department of Social Services
- Forest County Potawatomi Community (Potawatomi Health & Wellness Center)
- Forest County Potawatomi Health & Wellness Center
- Margaret Gother, PT
- Debra Ann Hilgart
- Michelle Lynn Huml, SACIT
- Theresa L Hunt, LPN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.