Healthcare Provider Details

I. General information

NPI: 1942718762
Provider Name (Legal Business Name): SIXTEENTH STREET COMMUNITY HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 S 5TH ST
MILWAUKEE WI
53207-1418
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: 414-672-4265
Mailing address:
  • Phone: 414-897-5511
  • Fax: 414-385-7552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JULIE B SCHULLER
Title or Position: CEO
Credential: MD
Phone: 414-672-1353