Healthcare Provider Details

I. General information

NPI: 1487875787
Provider Name (Legal Business Name): ST. CROIX CHIPPEWA INDIANS OF WI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 STATE RD 70
WEBSTER WI
54893
US

IV. Provider business mailing address

4404 STATE RD 70
WEBSTER WI
54893
US

V. Phone/Fax

Practice location:
  • Phone: 715-349-8554
  • Fax: 715-349-8529
Mailing address:
  • Phone: 715-349-8554
  • Fax: 715-349-8529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMBER HEINZ
Title or Position: HEALTH DIRECTOR
Credential:
Phone: 715-349-8554