| Lakeshore Community Health Care, Inc | |
|
1721 Saemann Avenue Sheboygan WI 53081-2341 | |
| (920) 783-6633 | |
| (920) 783-6392 |
| Full Name | Lakeshore Community Health Care, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1721 Saemann Avenue, Sheboygan, Wisconsin |
| Authorized Official Name and Position | David E Hughes (CFO/COO) |
| Authorized Official Contact | 9207836633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Community Health Care, Inc Po Box 959 Sheboygan WI 53082-0959 Ph: (920) 783-6633 | Lakeshore Community Health Care, Inc 1721 Saemann Avenue Sheboygan WI 53081-2341 Ph: (920) 783-6633 |
| NPI Number | 1144698549 |
|---|---|
| Provider Enumeration Date | 09/02/2015 |
| Last Update Date | 09/02/2015 |
| Medicare PECOS PAC ID | 3173773124 |
|---|---|
| Medicare Enrollment ID | O20121029000074 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144698549 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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Lakeshore Community Health Care, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 510 S. 8th Street, Sheboygan, WI 53081 Phone: 920-783-6633 Fax: 920-783-6392 | |
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