Provider Demographics
NPI:1679572788
Name:SOUTHWESTERN WISCONSIN COMMUNITY ACTION PROGRAM, INC.
Entity type:Organization
Organization Name:SOUTHWESTERN WISCONSIN COMMUNITY ACTION PROGRAM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:641-590-3677
Mailing Address - Street 1:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-0704
Mailing Address - Country:US
Mailing Address - Phone:608-348-9766
Mailing Address - Fax:608-348-3915
Practice Address - Street 1:65 S ELM ST
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3107
Practice Address - Country:US
Practice Address - Phone:608-348-9766
Practice Address - Fax:608-348-3915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWESTERN WISCONSIN COMMUNITY ACTION PROGRAM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-20
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43973600Medicaid
WI41863200Medicaid
WI44008100Medicaid
WI42005400Medicaid