Healthcare Provider Details

I. General information

NPI: 1174910012
Provider Name (Legal Business Name): SIXTEENTH STREET COMMUNITY HEALTH CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 S 9TH ST
MILWAUKEE WI
53204-3519
US

IV. Provider business mailing address

1337 S CESAR E CHAVEZ DR
MILWAUKEE WI
53204-2712
US

V. Phone/Fax

Practice location:
  • Phone: 414-672-1353
  • Fax: 414-385-7552
Mailing address:
  • Phone: 414-385-6299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number1507-800
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TANYA M STAMPS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 414-897-5407