| Organization Name: | SOKAOGON CHIPPEWA HEALTH CLINIC |
| NPI Number: | 1033115456 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAULETTE SMITH (CLINIC HEALTH DIRECTOR) |
| Mailing Address: | 3163 State Highway 55 Crandon |
| State: | WI US |
| Postal Code: | 545200275 |
| Phone Number: | 7154785180 |
| Fax Number: | 7154785904 |
| NPI Enumeration Date: | 06/21/2005 |
| NPI Last Update Date: | 11/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | 32957000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |