Basic Information
Provider Information | |||||||||
NPI: | 1285872358 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ACCESS COMMUNITY HEALTH CENTERS, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2901 W BELTLINE HWY | ||||||||
Address2: | SUITE 120 | ||||||||
City: | MADISON | ||||||||
State: | WI | ||||||||
PostalCode: | 537134226 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6084435500 | ||||||||
FaxNumber: | 6084412385 | ||||||||
Practice Location | |||||||||
Address1: | 2901 W BELTLINE HWY | ||||||||
Address2: | SUITE 120 | ||||||||
City: | MADISON | ||||||||
State: | WI | ||||||||
PostalCode: | 537134226 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6084435500 | ||||||||
FaxNumber: | 6084412385 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/28/2009 | ||||||||
LastUpdateDate: | 08/03/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HOLLAND | ||||||||
AuthorizedOfficialFirstName: | JOANNE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
AuthorizedOfficialTelephone: | 6084435518 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | 37-800 | WI | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
ID | Type | State | Issuer | Description | 32957700 | 01 | WI | THIS IS ACHC'S EXTRA NPI (IF ACHC EVER OPENS A NEW MEDICAL CLINIC USE THIS NPI) | OTHER |