| Stockbridge Munsee Health & Wellness Ctr | |
|
W12802 Cty Rd A Bowler WI 54416 | |
| (715) 793-4144 | |
| (715) 793-5028 |
| Full Name | Stockbridge Munsee Health & Wellness Ctr |
|---|---|
| Speciality | Clinic/Center |
| Location | W12802 Cty Rd A, Bowler, Wisconsin |
| Authorized Official Name and Position | Wallace A. Miller (TRIBAL CHAIRMAN) |
| Authorized Official Contact | 7157934111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stockbridge Munsee Health & Wellness Ctr P.o. Box 70 W12802 Cty Rd A Bowler WI 54416 Ph: (715) 793-4144 | Stockbridge Munsee Health & Wellness Ctr W12802 Cty Rd A Bowler WI 54416 Ph: (715) 793-4144 |
| NPI Number | 1629070180 |
|---|---|
| Provider Enumeration Date | 08/15/2005 |
| Last Update Date | 11/27/2013 |
| Medicare PECOS PAC ID | 9830094655 |
|---|---|
| Medicare Enrollment ID | O20031204000904 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629070180 | NPI | - | NPPES |
| 32955900 | Medicaid | WI | |
| 41730300 | Medicaid | WI | |
| 44008700 | Medicaid | WI | |
| 39114544+040 | Other | WI | BLUE CROSS BLUE SHIELD |
| 42125400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Richard D Dalve |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1669467882 PECOS PAC ID: 5890691232 Enrollment ID: I20031208000978 |
| Provider Name | James M Turnbull |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558343319 PECOS PAC ID: 6608772959 Enrollment ID: I20031209000378 |
| Provider Name | Dennis D Elmergreen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922172675 PECOS PAC ID: 7517863707 Enrollment ID: I20031209000607 |
| Provider Name | Sharon Stake |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942271846 PECOS PAC ID: 5496785461 Enrollment ID: I20050818000913 |
| Provider Name | Patrick A Mckenna |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831358142 PECOS PAC ID: 0941487359 Enrollment ID: I20110613000612 |
| Provider Name | Terri S Graham |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1194105387 PECOS PAC ID: 9739491051 Enrollment ID: I20150629003129 |
| Provider Name | Krystyna D Ostrowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619455607 PECOS PAC ID: 6002152451 Enrollment ID: I20190107002206 |
| Provider Name | Michael Saul Lundin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740661529 PECOS PAC ID: 3870824212 Enrollment ID: I20200323001822 |
| Provider Name | Krissa M Pyrch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740676592 PECOS PAC ID: 2466761374 Enrollment ID: I20200330000519 |
| Provider Name | Avari Marie Miller |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1588310148 PECOS PAC ID: 5698160331 Enrollment ID: I20220316002773 |
| Provider Name | Megan Elizabeth Moede |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568189405 PECOS PAC ID: 2567827082 Enrollment ID: I20230504002641 |
Stockbridge-munsee Health And Wellness Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: W12802 County Highway A, Bowler, WI 54416 Phone: 715-793-4144 Fax: 715-793-4120 |