MEDICARE: SIXTEENTH STREET COMMUNITY HEALTH CENTER 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)
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1174265854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIXTEENTH STREET COMMUNITY HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 778789
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-0001
Country	:	US
Telephone Number	:	414-672-1353
Fax Number	:	414-672-0191

Provider Business Practice Location Address
First Line	:	1817 W LINCOLN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2691
Country	:	US
Telephone Number	:	414-672-1353
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	TANYA M STAMPS
Credential	:
Telephone Number	:	414-897-5407

Provider Enumeration Date	:	04/12/2022
Last Update Date	:	01/08/2025

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