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1285741306

NPI Code Detail

MEDICARE: FOREST COUNTY POTAWATOMI COMMUNITY

MEDICARE: FOREST COUNTY POTAWATOMI 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
1	132700000X	Dietary Manager
2	133N00000X	Nutritionist
3	208000000X	Pediatrics Physician
4	261QC1500X	Community Health Clinic/Center
5	261QD0000X	Dental Clinic/Center
6	261QH0700X	Hearing and Speech Clinic/Center
7	261QP1100X	Podiatric Clinic/Center
8	261QR0200X	Radiology Clinic/Center
9	261QR0206X	Mammography Clinic/Center
10	291U00000X	Clinical Medical Laboratory
11	332800000X	Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
12	332B00000X	Durable Medical Equipment & Medical Supplies
13	332H00000X	Eyewear Supplier
14	332S00000X	Hearing Aid Equipment
15	261QF0400X	Federally Qualified Health Center (FQHC)		WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	DA0385	OTHER	WI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	391235059016	OTHER	WI	BLUE CROSS BLUE SHIELD
2	41752300	OTHER	WI	DURABLE MEDICAL EQUIPMENT
3	42182600	OTHER	WI	AODA CLINIC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	42182600	OTHER	WI	MENTAL HEALTH
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	44006100	OTHER	WI	PRENATAL CARE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285741306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREST COUNTY POTAWATOMI COMMUNITY

Provider Business Mailing Address
First Line	:	PO BOX 396
Second Line	:
City	:	CRANDON
State	:	WI
Zip	:	54520-0396
Country	:	US
Telephone Number	:	715-478-4300
Fax Number	:	715-478-4490

Provider Business Practice Location Address
First Line	:	8201 MISH KO SWEN DRIVE
Second Line	:
City	:	CRANDON
State	:	WI
Zip	:	54520-8631
Country	:	US
Telephone Number	:	715-478-4300
Fax Number	:	715-478-4300

Authorized Official
Title or Position	:	TRIBAL CHAIRMAN
Name	:	MR. NED DANIELS
Credential	:
Telephone Number	:	715-478-4824

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	12/09/2020

Similar Medicare Providers

1437141579 — RENEE LYNN WALDEN OD
Practice Location Address:

8201 MISH KO SWEN DR
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Practice Fax:

1962432658 — BONNIE M SAMUELSON M.D.
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1376650499 — FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER
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1407937428 — LISA M ZANT PTA
Practice Location Address:

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1699856609 — MARGARET GOTHER PT
Practice Location Address:

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1508025347 — ANDREW D KELLY PT
Practice Location Address:

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Directions to “FOREST COUNTY POTAWATOMI 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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