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General NPI Number Information
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NPI Number | 1629070180
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Entity Type | Organization
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Legal Business Name | STOCKBRIDGE MUNSEE COMMUNITY
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | W12802 CTY RD A
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City | BOWLER
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State | WI
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Zip | 54416
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Country | US
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Telephone | 715-793-4144
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Fax | 715-793-5028
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Provider Business Mailing Address
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Address Line | P.O. BOX 70 W12802 CTY RD A
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City | BOWLER
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State | WI
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Zip | 54416
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Country | US
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Telephone | 715-793-4144
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Fax | 715-793-5028
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Authorized Official
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Title or Position | TRIBAL CHAIRMAN
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Name | MR. WALLACE A. MILLER
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Credential |
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Telephone | 715-793-4111
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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 |
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License Number State |
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