Provider Demographics
NPI:1801229653
Name:SIXTEEN STREET COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SIXTEEN STREET COMMUNITY HEALTH CENTER
Other - Org Name:WAUKESHA COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA,FACP
Authorized Official - Phone:414-672-1353
Mailing Address - Street 1:309 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3718
Mailing Address - Country:US
Mailing Address - Phone:262-408-2530
Mailing Address - Fax:
Practice Address - Street 1:1337 S CESAR E CHAVEZ DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2712
Practice Address - Country:US
Practice Address - Phone:414-672-1354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1513-226261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center