LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Medical Equipment Supplier Yellow Pages
Lac Du Flambeau, Wisconsin
Provider NPI: 1447271408
Organization Information:Organization Name: LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Practice Location:
129 OLD ABE RD LAC DU FLAMBEAU, WI 54538 US
Tel: 715-588-3371 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
129 OLD ABE RD LAC DU FLAMBEAU, WI 54538 US
Tel: 715-588-3371 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 332800000X | Suppliers Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | WI | 8933-042 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
NCPDP PROVIDER IDENTIFICATION NUMBER | 5122382 | 01 | |
32956800 | WI | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin