Healthcare Provider Details

I. General information

NPI: 1083679385
Provider Name (Legal Business Name): SIXTEENTH STREET COMMUNITY HEALTH CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E NORTH ST
WAUKESHA WI
53188-3718
US

IV. Provider business mailing address

2906 S 20TH ST
MILWAUKEE WI
53215-3732
US

V. Phone/Fax

Practice location:
  • Phone: 414-672-1353
  • Fax:
Mailing address:
  • Phone: 414-672-1353
  • Fax: 414-672-4265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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