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General NPI Number Information
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NPI Number | 1598890378
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Entity Type | Organization
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Legal Business Name | LAC COURTE OREILLES GOVERNING
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 9940 N COUNTY HWY K
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City | HAYWARD
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State | WI
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Zip | 54843-2186
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Country | US
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Telephone | 715-638-5169
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Fax |
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Provider Business Mailing Address
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Address Line | 9940 N COUNTY HWY K
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City | HAYWARD
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State | WI
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Zip | 54843-2186
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Country | US
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Telephone | 715-638-5169
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | RAE E BAKER
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Credential |
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Telephone | 715-638-5169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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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 | 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 #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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