| Bad River Band Of Lake Superior Tribe Of Chippewa Indians Wis | |
|
53585 Nokomis Road Ashland WI 54806-4272 | |
| (715) 682-7133 | |
| (715) 685-7857 |
| Full Name | Bad River Band Of Lake Superior Tribe Of Chippewa Indians Wis |
|---|---|
| Speciality | Clinic/Center |
| Location | 53585 Nokomis Road, Ashland, Wisconsin |
| Authorized Official Name and Position | Debra Ann Tutor (CLINIC ADMINISTRATOR) |
| Authorized Official Contact | 7156827133 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bad River Band Of Lake Superior Tribe Of Chippewa Indians Wis 53585 Nokomis Road Ashland WI 54806-4272 Ph: (715) 682-7133 | Bad River Band Of Lake Superior Tribe Of Chippewa Indians Wis 53585 Nokomis Road Ashland WI 54806-4272 Ph: (715) 682-7133 |
| NPI Number | 1699701375 |
|---|---|
| Provider Enumeration Date | 06/24/2006 |
| Last Update Date | 04/06/2016 |
| Medicare PECOS PAC ID | 7810089414 |
|---|---|
| Medicare Enrollment ID | O20090825000440 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699701375 | NPI | - | NPPES |
| TRZ020 | Other | WI | TRAILBLAZER/MEDICARE |
| 32957600 | Medicaid | WI |
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