NPI Registry.org

Lake Superior Community Health Center

NPI Registration Record

Provider / OrganizationNPIDate Certified
LAKE SUPERIOR COMMUNITY HEALTH CENTER10637890222011-11-18

The organization Lake Superior Community Health Center is registered with the National Plan and Provider Enumeration System (NPPES) and has the assigned NPI of 1063789022. Registration indicates Lake Superior Community Health Center is a provider of services with a specialization in Ambulatory Health Care Facilities, Clinic/Center (Clinic/Center: Federally Qualified Health Center (FQHC),, ) (FQHC/Birthing Cntr/Health Dept/Home Health/RHC/Priv Duty Nurse, ) (Clinic/Center Federally Qualified Health Center (FQHC),, Ambulatory Health Care Facilities) (Clinic/Center, )

Entity TypeOrganization
Provider OrganizationLAKE SUPERIOR COMMUNITY HEALTH CENTER
Practice Office Address2222 E 5TH ST
SUPERIOR, WI US
Practice Office Telephone7153921955
Practice Office Fax7153921935
Mailing Address2222 E 5TH ST
SUPERIOR, WI 548803709 US
Business Telephone7153921955
Business Fax7153921935
Authorized OfficialLEE HOMAN, CEO
7153921955
HPT Codes
CodePractice
License No
State
261QF0400X PRIMARY
Ambulatory Health Care Facilities
Clinic/Center
Clinic/Center: Federally Qualified Health Center (FQHC),

FQHC/Birthing Cntr/Health Dept/Home Health/RHC/Priv Duty Nurse

Clinic/Center Federally Qualified Health Center (FQHC),
Ambulatory Health Care Facilities
Clinic/Center
OPI Codes
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