| Lake Superior Community Health Center | |
|
2222 E 5th St Superior WI 54880-3709 | |
| (715) 392-1955 | |
| (715) 392-1935 |
| Full Name | Lake Superior Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 2222 E 5th St, Superior, Wisconsin |
| Authorized Official Name and Position | Lee Homan (CEO) |
| Authorized Official Contact | 7153921955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Superior Community Health Center 2222 E 5th St Superior WI 54880-3709 Ph: (715) 392-1955 | Lake Superior Community Health Center 2222 E 5th St Superior WI 54880-3709 Ph: (715) 392-1955 |
| NPI Number | 1063789022 |
|---|---|
| Provider Enumeration Date | 11/18/2011 |
| Last Update Date | 02/13/2024 |
| Medicare PECOS PAC ID | 6608810031 |
|---|---|
| Medicare Enrollment ID | O20110205000134 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063789022 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Emily J Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770551335 PECOS PAC ID: 0042242364 Enrollment ID: I20070926000244 |
| Provider Name | Jacob R Oestreich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700854262 PECOS PAC ID: 6709818016 Enrollment ID: I20110211001001 |
| Provider Name | Erick R Anderson |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1710960984 PECOS PAC ID: 0244288041 Enrollment ID: I20120420000039 |
| Provider Name | Aaron D Pust |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629366968 PECOS PAC ID: 8820240625 Enrollment ID: I20130212000211 |
| Provider Name | Brittany Hamm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417598079 PECOS PAC ID: 6305178906 Enrollment ID: I20201117002043 |
| Provider Name | Kraig Robert Peterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093293326 PECOS PAC ID: 4688088768 Enrollment ID: I20210203000851 |
| Provider Name | Nicole Shockley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124569041 PECOS PAC ID: 5597040071 Enrollment ID: I20210307000003 |
| Provider Name | Greg A Mcgillivray |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1699771337 PECOS PAC ID: 3870541576 Enrollment ID: I20220217000552 |
| Provider Name | Kara Ward Mcgillivray |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1255337937 PECOS PAC ID: 0143278846 Enrollment ID: I20220316003498 |
| Provider Name | Jason C Bramstedt |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1487647723 PECOS PAC ID: 4587697198 Enrollment ID: I20220915002917 |
| Provider Name | Joellyn Steele |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1467902304 PECOS PAC ID: 1052760931 Enrollment ID: I20231218003138 |
| Provider Name | Ruby L Brewer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336801158 PECOS PAC ID: 2466896451 Enrollment ID: I20240217000752 |
Integrated Wound Care Management Wisconsin Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1800 New York Ave, Superior, WI 54880 Phone: 201-870-1194 | |
Twin Ports Health Solutions Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1728 Tower Ave, Superior, WI 54880 Phone: 715-395-0928 | |
Superior Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3500 Tower Ave, Superior, WI 54880 Phone: 715-395-5454 | |
Mariner Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 N 28th St E, Superior, WI 54880 Phone: 715-395-3900 | |
Lake Superior Community Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3600 Tower Avenue, Superior, WI 54880 Phone: 715-392-1955 Fax: 715-392-1935 | |
Lake Superior Community Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1500 N 34th St Ste 200, Superior, WI 54880 Phone: 715-395-5380 Fax: 715-394-2682 |