Basic Information
| Provider Information | |||||||||
| NPI: | 1568675858 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCESS COMMUNITY HEALTH CENTERS, INC. | ||||||||
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| 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: | 2202 S PARK ST | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537131916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084435500 | ||||||||
| FaxNumber: | 6084435534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 08/03/2016 | ||||||||
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| AuthorizedOfficialLastName: | HOLLAND | ||||||||
| AuthorizedOfficialFirstName: | JOANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6084435518 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 | 05 | WI | MEDICAID |