| Sokaogon Chippewa Community | |
|
3144 Vanzile Rd Crandon WI 54520-8149 | |
| (715) 478-5180 | |
| (715) 478-5904 |
| Full Name | Sokaogon Chippewa Community |
|---|---|
| Speciality | Clinic/Center |
| Location | 3144 Vanzile Rd, Crandon, Wisconsin |
| Authorized Official Name and Position | Leah Newton (BILLING MANAGER) |
| Authorized Official Contact | 7156220293 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sokaogon Chippewa Community 3144 Vanzile Rd Crandon WI 54520-8149 Ph: (715) 478-5180 | Sokaogon Chippewa Community 3144 Vanzile Rd Crandon WI 54520-8149 Ph: (715) 478-5180 |
| NPI Number | 1033115456 |
|---|---|
| Provider Enumeration Date | 06/21/2005 |
| Last Update Date | 09/01/2022 |
| Medicare PECOS PAC ID | 1759370869 |
|---|---|
| Medicare Enrollment ID | O20040512000238 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033115456 | NPI | - | NPPES |
| 32957000 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 32957000 (Wisconsin) | Primary |
| Provider Name | Shannon S Meyer |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1316933542 PECOS PAC ID: 4486550613 Enrollment ID: I20031209000837 |
| Provider Name | Gary M Pusateri |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1851383525 PECOS PAC ID: 2668408071 Enrollment ID: I20050715000938 |
| Provider Name | Eunice Corujo Incha |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1255371837 PECOS PAC ID: 9931125994 Enrollment ID: I20051019000215 |
| Provider Name | Allen Craig Orth |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1073548517 PECOS PAC ID: 3870597545 Enrollment ID: I20060912000158 |
| Provider Name | Suzette L Katchko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073773677 PECOS PAC ID: 4880758721 Enrollment ID: I20090121000668 |
| Provider Name | Stephanie Coons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467733576 PECOS PAC ID: 0042460313 Enrollment ID: I20121022000728 |
| Provider Name | Bobbi Jo K Bissonette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366874489 PECOS PAC ID: 1355575184 Enrollment ID: I20131010001708 |
| Provider Name | Melinda Roth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154757045 PECOS PAC ID: 5698900231 Enrollment ID: I20170920002093 |
| Provider Name | Abigail B Ashbeck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437827441 PECOS PAC ID: 4789048943 Enrollment ID: I20230907000493 |
| Provider Name | Lynette M Mccorkle |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609115682 PECOS PAC ID: 7416305727 Enrollment ID: I20240228002465 |
| Provider Name | Rachel A Mitnick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326664319 PECOS PAC ID: 5193134096 Enrollment ID: I20240914000193 |
| Provider Name | Kristen Radloff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003261215 PECOS PAC ID: 3870025737 Enrollment ID: I20241016002696 |
| Provider Name | Cullen Richard Shanrock |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1083298673 PECOS PAC ID: 8022543735 Enrollment ID: I20241120000560 |
Northwoods Behavioral Health Center, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 600 W Broad St, Crandon, WI 54520 Phone: 920-217-7910 | |
The Center For Human Restoration, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 505 W Glen St Ste 1, Crandon, WI 54520 Phone: 715-478-5202 Fax: 715-478-5205 |