| Lac Vieux Desert Band Of Lake Superior Chippewa Indians | |
|
N5241 Us Highway 45 Watersmeet MI 49969-0009 | |
| (906) 358-4588 | |
| (906) 358-4118 |
| Full Name | Lac Vieux Desert Band Of Lake Superior Chippewa Indians |
|---|---|
| Speciality | Clinic/Center |
| Location | N5241 Us Highway 45, Watersmeet, Michigan |
| Authorized Official Name and Position | James Williams (LAC VIEUX DESERT TRIBAL CHAIRMAN) |
| Authorized Official Contact | 9063584577 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lac Vieux Desert Band Of Lake Superior Chippewa Indians Po Box 9 Watersmeet MI 49969-0009 Ph: (906) 358-4588 | Lac Vieux Desert Band Of Lake Superior Chippewa Indians N5241 Us Highway 45 Watersmeet MI 49969-0009 Ph: (906) 358-4588 |
| NPI Number | 1114071578 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 09/11/2023 |
| Medicare PECOS PAC ID | 2567629181 |
|---|---|
| Medicare Enrollment ID | O20120208000892 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114071578 | NPI | - | NPPES |
| OB74513 | Other | MI | BLUE CROSS BLUE SHIELD |
| 1114071578 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |