Organization Name: | FOREST COUNTY POTAWATOMI COMMUNITY |
NPI Number: | 1285741306 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID BERTRAND (HEALTH DIVISION DIRECTOR) |
Mailing Address: | 8201 Mish Ko Swen Drive Crandon |
State: | WI US |
Postal Code: | 545208631 |
Phone Number: | 7154784300 |
Fax Number: | 7154784300 |
NPI Enumeration Date: | 08/24/2006 |
NPI Last Update Date: | 01/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332800000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
Taxonomy Specialization: | |
Taxonomy Definition: | An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. |