STOCKBRIDGE MUNSEE COMMUNITY (NPI# 1629070180) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629070180 |
| Entity Type | Organization |
| Organization Name | STOCKBRIDGE MUNSEE COMMUNITY |
| Other Organization Name | STOCKBRIDGE MUNSEE HEALTH & WELLNESS CTR |
| Practice Address |
W12802 Cty Rd A Bowler WI 54416 |
| Mailing Address |
P.o. Box 70 W12802 Cty Rd A Bowler WI 54416 |
| Practice Telephone | 7157934144 |
| Practice Fax Number | 7157935028 |
| Mailing Telephone | 7157934144 |
| Mailing Fax Number | 7157935028 |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2013-11-27 |
| Authorized Official Name | MR. WALLACE A. MILLER (TRIBAL CHAIRMAN) |
| Authorized Official Telephone | 7157934111 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | BLUE CROSS BLUE SHIELD | 39114544+040 | 01 |
| WI | 44008700 | 05 | |
| WI | 41730300 | 05 | |
| WI | 32955900 | 05 | |
| WI | 42125400 | 05 |
| Other Name | Type Code |
|---|---|
| Stockbridge Munsee Health & Wellness Ctr | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942331467 | Stockbridge Munsee Community | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | W12802 County Road A, Bowler, WI 54416-0086 | 2007-03-08 |
| Street Address |
W12802 CTY RD A |
| City | BOWLER |
| State | WI |
| Zip Code | 54416 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730602442 | Jennifer Potts | Counselor | 6200 Excelsior Blvd Ste 204, St. Louis Park, MN 54416 | 2017-07-25 |
| 1285020701 | Donna L Powless | Counselor | W12802 Cty Hwy A, Bowler, WI 54416 | 2015-04-10 |
| 1174518385 | Thomas Paul Wargo | Chiropractor | W12802 County Highway A, Bowler, WI 54416 | 2005-09-14 |
| 1720646433 | Jodie Colleen Skenandore | Counselor | W12802 County Highway A, Bowler, WI 54416 | 2019-05-29 |
| 1033677216 | Marlene B Miller | Counselor | W12802 County Highway A, Bowler, WI 54416 | 2019-03-07 |
| 1952891020 | Whitney Marie Schreiber | Registered Nurse | W12802 Cty Hwy A, Bowler, WI 54416 | 2018-05-15 |
| 1245686047 | Stockbridge Munsee Health and Wellness Center | Clinic/Center | W12802 Cty Hwy A, Bowler, WI 54416 | 2016-05-11 |
| 1013398387 | Paul Favela | Dentist | W12802 Cty Hwy A, Bowler, WI 54416 | 2015-06-12 |
| 1659767382 | Stockbridge-munsee Health and Wellness Center | Clinic/Center | W12802 County Highway A, Bowler, WI 54416 | 2015-04-09 |
| 1063731917 | Lisa Mohawk | Counselor | W12802 County Hwy A, Bowler, WI 54416 | 2010-05-18 |
| Find all providers in zip 54416 | ||||
| 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 |
| Find all providers with the same taxonomy | ||||
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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.