| Gerald L. Ignace Indian Health Center, Inc. | |
|
930 W Historic Mitchell St Milwaukee WI 53204-3533 | |
| (414) 383-9526 | |
| (414) 649-6711 |
| Full Name | Gerald L. Ignace Indian Health Center, Inc. |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 930 W Historic Mitchell St, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Lyle A. Ignace (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4143839526 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gerald L. Ignace Indian Health Center, Inc. 930 W Historic Mitchell St Milwaukee WI 53204-3533 Ph: (414) 383-9526 | Gerald L. Ignace Indian Health Center, Inc. 930 W Historic Mitchell St Milwaukee WI 53204-3533 Ph: (414) 383-9526 |
| NPI Number | 1023064086 |
|---|---|
| Provider Enumeration Date | 05/25/2006 |
| Last Update Date | 12/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023064086 | NPI | - | NPPES |
| 32957100 | Medicaid | WI | |
| 093488131 | Other | WI | CHAMPUS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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