MEDICARE: SIXTEENTH STREET COMMUNITY HEALTH CENTERS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	1507-800	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649559642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIXTEENTH STREET COMMUNITY HEALTH CENTERS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 778789
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-8789
Country	:	US
Telephone Number	:	414-672-1353
Fax Number	:	262-408-5094

Provider Business Practice Location Address
First Line	:	730 W WASHINGTON ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-2310
Country	:	US
Telephone Number	:	414-672-1353
Fax Number	:	262-408-5094

Authorized Official
Title or Position	:	CFO
Name	:	MARIA CECILIA S TAYLOR
Credential	:
Telephone Number	:	414-803-6395

Provider Enumeration Date	:	08/08/2011
Last Update Date	:	05/15/2023

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