LAKE SUPERIOR COMMUNITY HEALTH CENTER (NPI# 1760013700) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760013700 |
| Entity Type | Organization |
| Organization Name | LAKE SUPERIOR COMMUNITY HEALTH CENTER |
| Practice Address |
210 3rd St Carlton MN 55718-7703 |
| Mailing Address |
3600 Tower Ave Superior WI 54880-5337 |
| Practice Telephone | 2183363524 |
| Mailing Telephone | 7153921955 |
| Mailing Fax Number | 7153921935 |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2020-07-17 |
| Authorized Official Name | DAYLE M PATTERSON (CEO) |
| Authorized Official Telephone | 7153955370 |
| 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 |
|---|---|---|---|
| MN | 876693600 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578781639 | Lake Superior Community Health Center | Clinic/Center | 3600 Tower Avenue, Superior, WI 54880-5337 | 2007-04-23 |
| 1699708297 | Lake Superior Community Health Center | Clinic/Center | 4325 Grand Avenue, Duluth, MN 55807-2730 | 2006-07-08 |
| 1013556638 | Lake Superior Community Health Center | Clinic/Center | 4602 Grand Ave Ste 1000, Duluth, MN 55807-2712 | 2019-12-30 |
| 1639684384 | Lake Superior Community Health Center | Clinic/Center | 1500 N 34th St Ste 200, Superior, WI 54880-4477 | 2017-12-04 |
| 1568832277 | Lake Superior Community Health Center | Clinic/Center | 4325 Grand Ave, Duluth, MN 55807-2730 | 2015-10-07 |
| 1063789022 | Lake Superior Community Health Center | Clinic/Center | 4325 Grand Ave, Duluth, MN 55807-2730 | 2011-11-18 |
| Street Address |
210 3RD ST |
| City | CARLTON |
| State | MN |
| Zip Code | 55718-7703 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285245233 | Kirsten K Komarek | Dental Hygienist | 210 3rd St, Carlton, MN 55718-7703 | 2020-08-13 |
| 1982765319 | Richard D Devorak | Dentist | 210 3rd St, Carlton, MN 55718-7703 | 2006-12-12 |
| 1427123751 | Jeffrey John Bertani | Dentist | 210 3rd St, Carlton, MN 55718-7703 | 2006-11-21 |
| 1023190642 | James A Adamczak | Dentist | 210 3rd St, Carlton, MN 55718-7703 | 2006-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093989543 | Robert Thomas Johnson | Dentist | 210 Third Street, Carlton, MN 55718 | 2008-04-16 |
| 1750494910 | City of Carlton | Ambulance | 100 4th St. North, Carlton, MN 55718 | 2006-08-15 |
| 1972677532 | C.a.r.e.-carlton | Substance Abuse Rehabilitation Facility | 810 3rd St, Suite 102, Carlton, MN 55718-3700 | 2006-11-17 |
| 1659598084 | Laura Lee Bodin | Licensed Practical Nurse | 1570 Olsonville Rd, Carlton, MN 55718-8112 | 2007-04-19 |
| 1215405063 | Heather Lea Sanvig | Social Worker | 1721 County Road 4, Carlton, MN 55718-8220 | 2018-11-09 |
| 1629699855 | Tori Jo Anderson | Physician Assistant | 1971 Lakeview Dr, Carlton, MN 55718-8239 | 2020-04-28 |
| 1386110591 | Gina Mott | Registered Nurse | 2777 County Road 144, Carlton, MN 55718-9120 | 2018-10-16 |
| 1629055231 | Inter-faith Care Center | Assisted Living Facility | 813 3rd St, Carlton, MN 55718-9201 | 2005-12-23 |
| 1134125644 | Inter-faith Care Center | Skilled Nursing Facility | 811 3rd St, Carlton, MN 55718-9228 | 2005-06-21 |
| 1508958232 | Linda Newlon | Physical Therapist | 811 3rd St, Carlton, MN 55718-9228 | 2006-09-29 |
| Find all providers in zip 55718 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1174141485 | Rural Health Care, Inc | Clinic/Center | 820 2nd Ave N Ste 1, Windom, MN 56101-1766 | 2020-07-13 |
| 1730707084 | Rural Health Care, Inc. | Clinic/Center | 201 N St Paul Ave Ste 1, Fulda, MN 56131-3004 | 2020-07-13 |
| 1205397395 | Health Start Sbc Creative Arts | Clinic/Center | 65 Kellogg Blvd E, Saint Paul, MN 55101-1106 | 2019-03-29 |
| 1982162434 | Family Health Care Center | Clinic/Center | 1104 7th Ave S # 92, Moorhead, MN 56563-0001 | 2019-03-04 |
| 1760949168 | Indian Health Board of Minneapolis, Inc | Clinic/Center | 2101 Minnehaha Avenue South, Minneapolis, MN 55404-3107 | 2019-02-22 |
| 1891266862 | Hennepin County | Clinic/Center | 41 N 12th St., Minneapolis, MN 55403-1325 | 2018-12-17 |
| 1700357779 | Hennepin County | Clinic/Center | 2211 Clinton Ave, Minneapolis, MN 55404-3656 | 2018-12-17 |
| 1487125597 | Hennepin County | Clinic/Center | 215 S 8th St, Minneapolis, MN 55402-2803 | 2018-12-16 |
| 1992276000 | Hennepin County | Clinic/Center | 2740 1st Ave S, Minneapolis, MN 55408-1611 | 2018-12-16 |
| 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.