MEDICARE: LAC COURTE OREILLES GOVERNING

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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1194830208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAC COURTE OREILLES GOVERNING

Provider Business Mailing Address
First Line	:	9940 N COUNTY HWY K
Second Line	:
City	:	HAYWARD
State	:	WI
Zip	:	54843-2186
Country	:	US
Telephone Number	:	715-638-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	9940 N COUNTY HWY K
Second Line	:
City	:	HAYWARD
State	:	WI
Zip	:	54843-2186
Country	:	US
Telephone Number	:	715-638-5169
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	RAE E BAKER
Credential	:
Telephone Number	:	715-638-5169

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	08/26/2025

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