Provider Demographics
NPI:1083352280
Name:SIXTEENTH STREET COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:SIXTEENTH STREET COMMUNITY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STAMPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-897-5407
Mailing Address - Street 1:1337 S CESAR E CHAVEZ DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-2712
Mailing Address - Country:US
Mailing Address - Phone:414-672-1353
Mailing Address - Fax:414-672-0191
Practice Address - Street 1:1644 S 9TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3426
Practice Address - Country:US
Practice Address - Phone:414-672-1353
Practice Address - Fax:414-672-0191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health