| Organization Name: | BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS |
| NPI Number: | 1699701375 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEBRA ANN TUTOR (CLINIC ADMINISTRATOR) |
| Mailing Address: | 53585 Nokomis Road Ashland |
| State: | WI US |
| Postal Code: | 548064272 |
| Phone Number: | 7156827133 |
| Fax Number: | 7156857857 |
| NPI Enumeration Date: | 06/24/2006 |
| NPI Last Update Date: | 04/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |