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NPI Code Detail

MEDICARE: SOKAOGON CHIPPEWA COMMUNITY

MEDICARE: SOKAOGON CHIPPEWA COMMUNITY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)32957000WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033115456
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOKAOGON CHIPPEWA COMMUNITY
Provider Business Mailing Address
First Line : 3144 VANZILE RD
Second Line :
City : CRANDON
State : WI
Zip : 54520-8149
Country : US
Telephone Number : 715-478-5180
Fax Number : 715-478-5904
Provider Business Practice Location Address
First Line : 3144 VANZILE RD
Second Line :
City : CRANDON
State : WI
Zip : 54520-8149
Country : US
Telephone Number : 715-478-5180
Fax Number : 715-478-5904
Authorized Official
Title or Position : CLINIC DIRECTOR
Name : CHRIS MCGESHICK
Credential :
Telephone Number : 715-478-5180
Provider Enumeration Date : 06/21/2005
Last Update Date : 03/25/2025

Similar Medicare Providers

1851383525 — MR. GARY M PUSATERI MD
Practice Location Address:
3144 VANZILE RD
CRANDON, WI
54520-8149
Practice Phone: 715-478-5180
Practice Fax:
1558379438 — MR. DAVID R KAUFMAN JR. RPH
Practice Location Address:
3144 VANZILE RD
CRANDON, WI
54520-8149
Practice Phone: 715-478-6429
Practice Fax:
1598954398 — DR. RICHARD ARTHUR BRANDNER M.D.
Practice Location Address:
3144 VANZILE RD
CRANDON, WI
54520-8149
Practice Phone: 715-478-5180
Practice Fax:
1073773677 — MRS. SUZETTE LINDA KATCHKO APNP
Practice Location Address:
3144 VANZILE RD
CRANDON, WI
54520-8149
Practice Phone: 715-478-5180
Practice Fax:
1467733576 — DR. STEPHANIE MARIE COONS DSW
Practice Location Address:
3144 VANZILE RD
CRANDON, WI
54520-8149
Practice Phone: 715-478-5180
Practice Fax:
1609115682 — LYNETTE M MCCORKLE LPC
Practice Location Address:
3144 VANZILE ROAD
CRANDON, WI
54520-8149
Practice Phone: 715-478-5180
Practice Fax: 715-478-5904

Directions to “SOKAOGON CHIPPEWA COMMUNITY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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