| Indianhead Medical Center | |
|
113 4th Ave Shell Lake WI 54871-4457 | |
| (715) 468-7833 | |
| (715) 468-7303 |
| Full Name | Indianhead Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 113 4th Ave, Shell Lake, Wisconsin |
| Authorized Official Name and Position | Shannon James Jack (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Contact | 7154687833 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indianhead Medical Center Po Box 300 Shell Lake WI 54871-0300 Ph: (715) 468-7833 | Indianhead Medical Center 113 4th Ave Shell Lake WI 54871-4457 Ph: (715) 468-7833 |
| NPI Number | 1659899078 |
|---|---|
| Provider Enumeration Date | 09/06/2017 |
| Last Update Date | 03/09/2020 |
| Medicare PECOS PAC ID | 6406748839 |
|---|---|
| Medicare Enrollment ID | O20171010001807 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659899078 | NPI | - | NPPES |
| 11020700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Shell Lake Clinic, Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 105 4th Ave, Shell Lake, WI 54871 Phone: 715-468-2711 Fax: 715-468-2727 | |
Stone Lake Rural Health Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 113 4th Avenue, Shell Lake, WI 54871 Phone: 715-468-7833 | |
Shell Lake Clinic, Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 105 4th Ave, Shell Lake, WI 54871 Phone: 715-468-2711 Fax: 715-468-2727 |