Healthcare Provider Details

I. General information

NPI: 1609012020
Provider Name (Legal Business Name): OUTREACH COMMUNITY HEALTH CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W CAPITOL DR FAMILY SERVICES CLINIC
MILWAUKEE WI
53212
US

IV. Provider business mailing address

210 W CAPITOL DR
MILWAUKEE WI
53212-1123
US

V. Phone/Fax

Practice location:
  • Phone: 414-727-6320
  • Fax:
Mailing address:
  • Phone: 414-727-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LATASHA M THOMPSON
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 414-964-9018