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General NPI Number Information
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NPI Number | 1033115456
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Entity Type | Organization
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Legal Business Name | SOKAOGON CHIPPEWA COMMUNITY
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 3144 VANZILE RD
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City | CRANDON
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State | WI
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Zip | 54520-8149
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Country | US
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Telephone | 715-478-5180
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Fax | 715-478-5904
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Provider Business Mailing Address
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Address Line | 3144 VANZILE RD
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City | CRANDON
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State | WI
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Zip | 54520-8149
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Country | US
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Telephone | 715-478-5180
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Fax | 715-478-5904
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | CHRIS MCGESHICK
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Credential |
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Telephone | 715-478-5180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 32957000
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License Number State | WI
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