Provider Demographics
NPI:1407978521
Name:WESTSIDE HEALTHCARE ASSOCIATION, INC
Entity Type:Organization
Organization Name:WESTSIDE HEALTHCARE ASSOCIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVENICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-935-8000
Mailing Address - Street 1:3522 W. LISBON AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208
Mailing Address - Country:US
Mailing Address - Phone:414-935-8000
Mailing Address - Fax:414-934-6081
Practice Address - Street 1:1452 N. 7TH STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205
Practice Address - Country:US
Practice Address - Phone:414-287-0919
Practice Address - Fax:414-287-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38021261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIH01388Medicare UPIN