NPIMap

Organization Active NPI

Westside Healthcare Association Inc

  • Family Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1245490127
Registry record updated Jun 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
49433 Issued in WI
Legal business name
WESTSIDE HEALTHCARE ASSOCIATION INC
Practice address
3522 W Lisbon Ave
Milwaukee, WI 53208-1953
Phone
(414) 935-8000
Fax
(414) 755-0058
NPI assigned
Jun 13, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Tangela M Poole
Title
Chief Financial Officer
Phone
(414) 934-7582

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 4109 WI
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 49433 WI Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X 2023 WI

Addresses

Primary practice location

3522 W Lisbon Ave
Milwaukee, WI 53208-1953

Mailing address

3522 W Lisbon Ave
Milwaukee, WI 53208-1953
Phone (414) 935-8000

Other identifiers 1

IdentifierTypeStateIssuer
32957400MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Progressive Community Health Centers Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1245490127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3522 W LISBON AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532081953",
            "telephone_number": "414-935-8000",
            "fax_number": "414-755-0058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3522 W LISBON AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532081953",
            "telephone_number": "414-935-8000",
            "fax_number": "414-755-0058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTSIDE HEALTHCARE ASSOCIATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-13",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "TANGELA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "414-934-7582",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "4109",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "49433",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2023",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32957400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.