Provider Demographics
NPI:1104127067
Name:AMERICAN COMMUNITY MEDICAL CENTER INC.
Entity type:Organization
Organization Name:AMERICAN COMMUNITY MEDICAL CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YASMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUF-SAFAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-443-9111
Mailing Address - Street 1:1421 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-2178
Mailing Address - Country:US
Mailing Address - Phone:608-441-6888
Mailing Address - Fax:608-441-6888
Practice Address - Street 1:1421 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-2178
Practice Address - Country:US
Practice Address - Phone:608-441-6888
Practice Address - Fax:608-441-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43432-20261Q00000X, 208D00000X, 207R00000X, 207Q00000X
208000000X, 207VG0400X
WI434322-020261QC1500X
WI1744363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1104127067Medicaid
WI1588705032OtherNPI