| Indianhead Medical Center Shell Lake, Inc. | |
|
7728 W Main St Siren WI 54872-8041 | |
| (153) 492-9107 | |
| Not Available |
| Full Name | Indianhead Medical Center Shell Lake, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 7728 W Main St, Siren, Wisconsin |
| Authorized Official Name and Position | Doris Jean Laursen (DIRECTOR OF NURSING) |
| Authorized Official Contact | 7154687833 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indianhead Medical Center Shell Lake, Inc. Po Box 58 Siren WI 54872-0058 Ph: (715) 349-2910 | Indianhead Medical Center Shell Lake, Inc. 7728 W Main St Siren WI 54872-8041 Ph: (153) 492-9107 |
| NPI Number | 1518432251 |
|---|---|
| Provider Enumeration Date | 10/09/2018 |
| Last Update Date | 10/09/2018 |
| Medicare PECOS PAC ID | 6406748839 |
|---|---|
| Medicare Enrollment ID | O20181025000389 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518432251 | NPI | - | NPPES |
| K100372638 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Indianhead Medical Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 7728 W Main St, Siren, WI 54872 Phone: 715-349-2910 Fax: 715-468-7303 |