MEDICARE: THE LAKES COMMUNITY HEALTH CENTER, INC

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	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

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

General Provider Information

NPI Number	:	1891452314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LAKES COMMUNITY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	15735 W US HIGHWAY 63
Second Line	:
City	:	HAYWARD
State	:	WI
Zip	:	54843-6475
Country	:	US
Telephone Number	:	715-934-0710
Fax Number	:	715-598-4881

Provider Business Practice Location Address
First Line	:	2119 HEIGHTS DR
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-6130
Country	:	US
Telephone Number	:	715-861-7901
Fax Number	:	715-861-7905

Authorized Official
Title or Position	:	CEO
Name	:	ANA TOCHTERMAN
Credential	:
Telephone Number	:	888-834-4551

Provider Enumeration Date	:	11/18/2021
Last Update Date	:	06/10/2025

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