| Lake Superior Community Health Center | |
|
4602 Grand Ave Ste 1000 Duluth MN 55807-2712 | |
| (218) 336-3520 | |
| (218) 624-6097 |
| Full Name | Lake Superior Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 4602 Grand Ave Ste 1000, Duluth, Minnesota |
| 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 4602 Grand Ave Ste 1000 Duluth MN 55807-2712 Ph: (218) 336-3520 |
| NPI Number | 1013556638 |
|---|---|
| Provider Enumeration Date | 12/30/2019 |
| Last Update Date | 02/13/2024 |
| Medicare PECOS PAC ID | 6608810031 |
|---|---|
| Medicare Enrollment ID | O20200904000311 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013556638 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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