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SHELL LAKE CLINIC, LTD
NPI 1083722805
Family Medicine in Shell Lake, WI

Active since August 29, 2006CLIA 52D0397130 · Waiver
105 4TH AVE, SHELL LAKE, WI 54871(715) 468-2711(715) 468-2727 Get Directions Write a Review

NPPES record last updated: October 23, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shell Lake Clinic, Ltd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHELL LAKE CLINIC, LTD (NPI 1083722805) is a healthcare organization registered as a family medicine in Shell Lake, Wisconsin and active in the NPI registry since August 2006. The organization holds a CLIA Waiver certificate valid through June 20, 2027 and lists Jeffrey L Dunham, President, as its authorized official.

NPPES Registry Identity

NPI1083722805
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameSHELL LAKE CLINIC, LTD
Location Address105 4TH AVEShell Lake, WI 54871-0336
Mailing Address105 4th Ave, P O Box 336Shell Lake, WI 54871-0336 · (715) 468-2711 · Fax (715) 468-2727
Phone(715) 468-2711
Fax(715) 468-2727
Organization SubpartNo
Authorized OfficialJeffrey L DunhamPresident · (715) 468-2711
Enumeration DateAugust 29, 2006
Last NPPES UpdateOctober 23, 2008
✔ NPI 1083722805 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
105 4TH AVE, Shell Lake, WI 54871
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Other Identifiers 3

Medicaid32751100WI
Medicare NSC0811960001WI
Medicare ID-Type Unspecified66020WI · Medicare

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D0397130

Shell Lake Clinic Ltd · Shell Lake, WI
Active · expires Jun 20, 2027
CLIA Number52D0397130
Laboratory TypeRural Health Clinic
Certificate Effective DateJune 21, 2025
Certificate Expiration DateJune 20, 2027
Laboratory DirectorDr. Alan J. Haesemeyer
Laboratory Phone(715) 468-2711
Laboratory LocationShell Lake Clinic Ltd105 4th Street PO Box 336, Shell Lake, WI 54871
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KENNETH JOE GARRISON M.D.
Surgery
105 4TH AVE
SHELL LAKE, WI 54871
Washburn County (715) 468-2711
SHELL LAKE CLINIC, LTD
Family Medicine
105 4TH AVE
SHELL LAKE, WI 54871
Washburn County (715) 468-2711
KENNETH J GARRISON, MD, SC
Surgery
105 4TH AVE
SHELL LAKE, WI 54871
Washburn County (715) 468-2711

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shell Lake Clinic, Ltd's NPI number?

The NPI number for Shell Lake Clinic, Ltd is 1083722805. It was assigned to this organization in the NPPES registry on August 29, 2006.

Where is Shell Lake Clinic, Ltd located?

Shell Lake Clinic, Ltd is located at 105 4th Ave, Shell Lake, WI 54871. The listed phone number is (715) 468-2711.

What is Shell Lake Clinic, Ltd's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Shell Lake Clinic, Ltd hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D0397130) is associated with this NPI, valid through June 20, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Shell Lake Clinic, Ltd was last updated on October 23, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.