Provider Demographics
NPI:1023228814
Name:SIXTEENTH STREET COMMUNITY HEALTH CENTERS INC
Entity type:Organization
Organization Name:SIXTEENTH STREET COMMUNITY HEALTH CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STAMPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-897-5407
Mailing Address - Street 1:1032 S 16TH ST
Mailing Address - Street 2:SUITE 219
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204
Mailing Address - Country:US
Mailing Address - Phone:414-672-3145
Mailing Address - Fax:414-383-5597
Practice Address - Street 1:2906 S 20TH STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-672-3145
Practice Address - Fax:414-383-5597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42205500Medicaid
WI521830Medicare Oscar/Certification
WI01545Medicare PIN