1891424602 NPI number — SIXTEENTH STREET COMMUNITY HEALTH CENTER

Table of content: (NPI 1891424602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891424602 NPI number — SIXTEENTH STREET COMMUNITY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIXTEENTH STREET COMMUNITY HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891424602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1337 S CESAR E CHAVEZ DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53204-2712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-672-1353
Provider Business Mailing Address Fax Number:
414-672-0191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 W LAPHAM BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53204-3296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-672-1353
Provider Business Practice Location Address Fax Number:
414-672-0191
Provider Enumeration Date:
06/07/2022

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
MARIA CECILIA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
414-897-5407

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com