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General NPI Number Information
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NPI Number | 1023064086
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Entity Type | Organization
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Legal Business Name | GERALD L. IGNACE INDIAN HEALTH CENTER, INC.
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 930 W HISTORIC MITCHELL ST
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City | MILWAUKEE
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State | WI
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Zip | 53204-3533
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Country | US
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Telephone | 414-383-9526
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Fax | 414-649-6711
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Provider Business Mailing Address
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Address Line | 930 W HISTORIC MITCHELL ST
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City | MILWAUKEE
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State | WI
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Zip | 53204-3533
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Country | US
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Telephone | 414-383-9526
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Fax | 414-389-3881
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT
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Name | MARIA SCHULNER
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Credential |
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Telephone | 414-383-5103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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