THE LAKES COMMUNITY HEALTH CENTER, INC (NPI# 1083961163) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083961163 |
| Entity Type | Organization |
| Organization Name | THE LAKES COMMUNITY HEALTH CENTER, INC |
| Other Organization Name | NORTHLAKES COMMUNITY CLINIC |
| Practice Address |
600 W Shell Creek Rd Minong WI 54859-9302 |
| Mailing Address |
15954 Rivers Edge Dr Ste 304 Hayward WI 54843-7894 |
| Practice Telephone | 7154662201 |
| Practice Fax Number | 7154662205 |
| Mailing Telephone | 7156342541 |
| Mailing Fax Number | 7155984881 |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2019-02-05 |
| Authorized Official Name | REBA RICE (CEO) |
| Authorized Official Telephone | 7153725001 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
26972 | WI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1811178825 | 05 |
| Other Name | Type Code |
|---|---|
| Northlakes Community Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659884716 | The Lakes Community Health Center, Inc | Clinic/Center | 15954 Rivers Edge Dr Ste 304, Hayward, WI 54843-7800 | 2017-11-13 |
| 1841742673 | The Lakes Community Health Center, Inc | Clinic/Center | 300 Main Street West, Ashland, WI 54806-3696 | 2016-10-27 |
| 1679983423 | The Lakes Community Health Center, Inc | Clinic/Center | 524 Bissell Street, White Lake, WI 54491 | 2014-05-02 |
| 1720215684 | The Lakes Community Health Center, Inc | Clinic/Center | 719 Main St East, Ashland, WI 54806-1918 | 2009-06-18 |
| 1699778233 | The Lakes Community Health Center, Inc | Clinic/Center | 15397 State Highway 32, Lakewood, WI 54138-9702 | 2005-05-27 |
| 1437719267 | The Lakes Community Health Center, Inc | Clinic/Center | 210 5th Ave N, Hurley, WI 54534-1209 | 2019-06-14 |
| 1437619202 | The Lakes Community Health Center, Inc | Clinic/Center | 500 Birch St, Park Falls, WI 54552-1415 | 2019-03-20 |
| 1750878542 | The Lakes Community Health Center, Inc | Clinic/Center | 108 S Main St, Birchwood, WI 54817 | 2018-04-17 |
| 1033569124 | The Lakes Community Health Center, Inc | Clinic/Center | 730 Swede Ave, Turtle Lake, WI 54889 | 2016-06-20 |
| 1124436159 | The Lakes Community Health Center, Inc | Clinic/Center | 15910 W Company Lake Rd, Hayward, WI 54843-5320 | 2014-07-22 |
| Street Address |
600 W SHELL CREEK RD |
| City | MINONG |
| State | WI |
| Zip Code | 54859-9302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760487722 | Frederick D Kosmach | Physician Assistant | 600 W Shell Creek Rd, Minong, WI 54859-9302 | 2005-06-16 |
| 1518306893 | The Lakes Community Health Center, Inc | Pharmacy | 600 W Shell Creek Rd, Minong, WI 54859-9302 | 2013-06-19 |
| 1952747610 | Orthopedic & Spine Therapy of Poplar Sc | Physical Therapist | 600 W Shell Creek Rd, Minong, WI 54859-9302 | 2013-05-21 |
| 1386833051 | Michael Mccusker | Physical Therapist | 600 W Shell Creek Rd, Suite 2, Minong, WI 54859-9302 | 2007-10-18 |
| 1871528083 | Heather L Runge | Physician Assistant | 600 W Shell Creek Rd, Minong, WI 54859-9145 | 2006-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649367509 | Dodson W Thompson | Emergency Medicine | 600 W Shell Creek Road, Minong, WI 54859 | 2006-10-10 |
| 1104005800 | Northwood School District | Local Education Agency (LEA) | N14463 Highway 53, Minong, WI 54859-9483 | 2007-10-30 |
| 1033585104 | Shauna Wallace | Occupational Therapy Assistant | N14463 Highway 53, Minong, WI 54859-9483 | 2015-08-12 |
| 1235346297 | Village of Minong | Clinic/Center | 123 5th Ave E, Minong, WI 54859-9541 | 2007-05-17 |
| 1912237389 | Rebecca Keith | Registered Nurse | 312 Business 53 Ste 7, Minong, WI 54859-9550 | 2010-01-07 |
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326693847 | Scenic Bluffs Health Center, Inc | Clinic/Center | 100 Blackhawk Dr, Viroqua, WI 54665-1315 | 2019-08-02 |
| 1942718762 | Sixteenth Street Community Health Centers, Inc. | Clinic/Center | 2607 S 5th St, Milwaukee, WI 53207-1418 | 2018-01-15 |
| 1659884716 | The Lakes Community Health Center, Inc | Clinic/Center | 15954 Rivers Edge Dr Ste 304, Hayward, WI 54843-7800 | 2017-11-13 |
| 1275056632 | Outreach Community Health Centers, Inc. | Clinic/Center | 9120 W Hampton Ave Ste 119, Milwaukee, WI 53225-4960 | 2017-07-18 |
| 1437695038 | Scenic Bluffs Health Center, Inc. | Clinic/Center | 200 West North Street, Norwalk, WI 54648 | 2017-01-06 |
| 1841742673 | The Lakes Community Health Center, Inc | Clinic/Center | 300 Main Street West, Ashland, WI 54806-3696 | 2016-10-27 |
| 1174071658 | Kenosha Community Health Center, Inc. | Clinic/Center | 2310 Center St, Racine, WI 53403-3330 | 2016-09-14 |
| 1841652021 | Scenic Bluffs Health Center, Inc. | Clinic/Center | 201 E Franklin St Rm B3, Sparta, WI 54656-1803 | 2016-03-25 |
| 1366844003 | Scenic Bluffs Health Center, Inc | Clinic/Center | 201 E Franklin St # B3, Sparta, WI 54656-1803 | 2014-09-25 |
| 1679983423 | The Lakes Community Health Center, Inc | Clinic/Center | 524 Bissell Street, White Lake, WI 54491 | 2014-05-02 |
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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.