Organization · Type 2 NPI

Lake Superior Community Health Center

Federally Qualified Health Center (FQHC) · Superior, WI

NPI number 1639684384 Active

Practice location

1500 N 34th St Ste 200
Superior, WI 54880-4477

Call (715) 395-5380 Map

Fax (715) 394-2682

Mailing address

1500 N 34th St
Superior, WI 54880-4477

Specialties and licenses

Taxonomy	Code	License
Federally Qualified Health Center (FQHC) Primary	261QF0400X	None listed

Federally Qualified Health Center (FQHC): Definition to come...

3 other providers at this address

Other federally qualified health center (fqhc) providers in Superior

Lake Superior Community Health CenterFederally Qualified Health Center (FQHC) Superior, WI NPI 1063789022
Lake Superior Community Health CenterFederally Qualified Health Center (FQHC) Superior, WI NPI 1578781639

See all in Superior →

NPI record

NPI: 1639684384
Entity type: Organization (Type 2)
Issued: Dec 4, 2017
Last updated: Feb 8, 2021
Status: Active

Other names

<unavail>
Lake Superior Community Health Center · doing business as
Lake Superior Community Health Center · doing business as

Authorized official

Jessie Peterson
COO
(218) 722-1497

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1639684384

Lake Superior Community Health Center's National Provider Identifier is 1639684384, issued on Dec 4, 2017. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Superior, WI. The record was last updated on Feb 8, 2021.