Healthcare Provider Details

I. General information

NPI: 1972725240
Provider Name (Legal Business Name): HO CHUNK NATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S2845 WHITE EAGLE RD
BARABOO WI
53913-9064
US

IV. Provider business mailing address

S2845 WHITE EAGLE RD
BARABOO WI
53913-9064
US

V. Phone/Fax

Practice location:
  • Phone: 608-355-5177
  • Fax: 608-356-1233
Mailing address:
  • Phone: 608-355-1240
  • Fax: 608-356-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number8332-42
License Number StateWI

VIII. Authorized Official

Name: WALLY L APLAND
Title or Position: HEALTH DEPT DIRECTOR OF FINANCE
Credential:
Phone: 715-284-9851