Provider Demographics
NPI:1821810565
Name:ST. CROIX CHIPPEWA INDIANS OF WI
Entity type:Organization
Organization Name:ST. CROIX CHIPPEWA INDIANS OF WI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:715-349-8554
Mailing Address - Street 1:24106 STATE ROAD 35 70
Mailing Address - Street 2:
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-8006
Mailing Address - Country:US
Mailing Address - Phone:715-349-2221
Mailing Address - Fax:
Practice Address - Street 1:24106 STATE ROAD 35 70
Practice Address - Street 2:
Practice Address - City:SIREN
Practice Address - State:WI
Practice Address - Zip Code:54872-8006
Practice Address - Country:US
Practice Address - Phone:715-349-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. CROIX CHIPPEWA INDIANS OF WI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy