INDIANHEAD MEDICAL CENTER SHELL LAKE, INC. (NPI# 1053859058) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053859058 |
| Entity Type | Organization |
| Organization Name | INDIANHEAD MEDICAL CENTER SHELL LAKE, INC. |
| Other Organization Name | INDIANHEAD MEDICAL CENTER |
| Practice Address |
7728 W Main St Siren WI 54872-8041 |
| Mailing Address |
Po Box 300 Shell Lake WI 54871-0300 |
| Practice Telephone | 7153492910 |
| Practice Fax Number | 7154687303 |
| Mailing Telephone | 7154687833 |
| Mailing Fax Number | 7154687303 |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2020-03-09 |
| Authorized Official Name | SHANNON JAMES JACK (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Telephone | 7154687833 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 11020710 | 05 |
| Other Name | Type Code |
|---|---|
| Indianhead Medical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518432251 | Indianhead Medical Center Shell Lake, Inc. | Clinic/Center | 7728 W Main St, Siren, WI 54872-8041 | 2018-10-09 |
| 1659899078 | Indianhead Medical Center Shell Lake, Inc. | Clinic/Center | 113 4th Ave, Shell Lake, WI 54871-4457 | 2017-09-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | INDIANHEAD MEDICAL CENTER SHELL LAKE, INC. | 113 4th Ave, Shell Lake, WI 54871-4457 |
| Street Address |
7728 W MAIN ST |
| City | SIREN |
| State | WI |
| Zip Code | 54872-8041 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518432251 | Indianhead Medical Center Shell Lake, Inc. | Clinic/Center | 7728 W Main St, Siren, WI 54872-8041 | 2018-10-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073989315 | Kristin L Barnes | Occupational Therapy Assistant | 7410 Co Hwy K, Siren, WI 54872 | 2015-08-20 |
| 1992113815 | In The Woods Apothecary | Pharmacy | 24106 State Rd 35, Siren, WI 54872 | 2014-07-23 |
| 1811137573 | Linda Slaikeu | Marriage & Family Therapist | 23758 State Rd 35, Siren, WI 54872 | 2009-02-20 |
| 1245405539 | Sarah L Busch | Counselor | 7670 Johnson Street, Siren, WI 54872 | 2008-04-28 |
| 1285760751 | Oak Park Dental Clinic | Clinic/Center | 24164 Highway 35-70, Siren, WI 54872 | 2007-02-26 |
| 1326113275 | Warren D Stouffer | Counselor | 24670 State Rd 35 70, Suite 1200 Aurora Community Counseling Employee Support, Siren, WI 54872 | 2006-11-22 |
| 1861464307 | April Dawn Svoboda Smith | Optometrist | 24082 State Road 35, Siren, WI 54872 | 2006-02-07 |
| 1659770113 | In The Woods Apothecary | Pharmacy | 24106 State Rd 35, Siren, WI 54872 | 2014-08-20 |
| 1063616571 | Siren Family Eyecare, LLC | Optometrist | 24082 State Road 35, Siren, WI 54872 | 2007-06-11 |
| 1578644639 | Hawkeye Enterprises LLC | Pharmacy | 24106 State Road 35, Siren, WI 54872-0000 | 2006-10-17 |
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| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.