| St. Croix Chippewa Indians Of Wisconsin | |
|
4404 State Road 70 Webster WI 54893-9251 | |
| (715) 349-8554 | |
| (715) 349-8529 |
| Full Name | St. Croix Chippewa Indians Of Wisconsin |
|---|---|
| Speciality | Clinic/Center |
| Location | 4404 State Road 70, Webster, Wisconsin |
| Authorized Official Name and Position | Karie Taylor (BUSINESS OFFICE MANAGER) |
| Authorized Official Contact | 7153498554 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Croix Chippewa Indians Of Wisconsin 4404 State Road 70 Webster WI 54893-9251 Ph: (715) 349-8554 | St. Croix Chippewa Indians Of Wisconsin 4404 State Road 70 Webster WI 54893-9251 Ph: (715) 349-8554 |
| NPI Number | 1831170091 |
|---|---|
| Provider Enumeration Date | 11/07/2005 |
| Last Update Date | 03/27/2024 |
| Medicare PECOS PAC ID | 1153369350 |
|---|---|
| Medicare Enrollment ID | O20050419000754 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831170091 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Wisconsin) | Primary |
| Provider Name | Shannon S Meyer |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1316933542 PECOS PAC ID: 4486550613 Enrollment ID: I20031209000837 |
| Provider Name | James P Fogarty |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1881689891 PECOS PAC ID: 1759270200 Enrollment ID: I20040312000429 |
| Provider Name | Brian D Smith |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1366483612 PECOS PAC ID: 7719979046 Enrollment ID: I20040330000742 |
| Provider Name | Joseph L Marek |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1457338139 PECOS PAC ID: 6406803477 Enrollment ID: I20050401000181 |
| Provider Name | Jean M Roedl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871643536 PECOS PAC ID: 9234253618 Enrollment ID: I20100908000369 |
| Provider Name | Heidi Dumas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194030445 PECOS PAC ID: 2062601545 Enrollment ID: I20110114000187 |
| Provider Name | Linda M.h. Benton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760575716 PECOS PAC ID: 0840415881 Enrollment ID: I20140707000684 |
Ingalls Family Medicine Clinic Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7456 Main St W, Webster, WI 54893 Phone: 715-866-4271 Fax: 715-866-4284 | |
Webster Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 26425 Lakeland Avenue South, Webster, WI 54893 Phone: 715-866-4271 Fax: 715-866-4284 |