Provider Demographics
NPI:1376851311
Name:PROGRESSIVE COMMUNITY HEALTH CENTERS, INC
Entity Type:Organization
Organization Name:PROGRESSIVE COMMUNITY HEALTH CENTERS, INC
Other - Org Name:HILLSIDE FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-935-8000
Mailing Address - Street 1:PO BOX 080257
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-8004
Mailing Address - Country:US
Mailing Address - Phone:414-935-8000
Mailing Address - Fax:
Practice Address - Street 1:1452 N 7TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-2301
Practice Address - Country:US
Practice Address - Phone:414-935-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32957400Medicaid
WI32957400Medicaid
521838Medicare Oscar/Certification