NPIMap

Organization Active NPI

MHS Convenient Care Clinic

  • Community Health Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1275767485
Registry record updated Nov 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Nurse PractitionerTaxonomy code 363LC1500X
License
6282-800 Issued in WI
Legal business name
MHS CONVENIENT CARE CLINIC
Practice address
4061 N 54TH St
Milwaukee, WI 53216-1377
Phone
(414) 372-8080
NPI assigned
May 4, 2009
Last updated
Nov 30, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
MILWAUKEE HEALTH SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 30, 2011

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

Authorized official

Name
Fran Bolden
Title
Credentialing Coordinator
Phone
(414) 372-8080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Nurse Practitioner 363LC1500X 6282-800 WI Primary

Addresses

Primary practice location

4061 N 54TH St
Milwaukee, WI 53216-1377

Mailing address

2555 N Martin Luther King Dr
Milwaukee, WI 53212-2709
Phone (414) 372-8080

Other identifiers 11

IdentifierTypeStateIssuer
521804OtherWIMEDICARE USG#
32831100MedicaidWI
33780500MedicaidWI
33724600MedicaidWI
33782900MedicaidWI
42183000MedicaidWI
521829OtherWIMEDICARE UGS#
1518005818MedicaidWI
32958200MedicaidWI
43086700MedicaidWI
44066400MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Milwaukee HLTH SRVS Inc9 organizations share this tax ID, including this one
Part of
Milwaukee HLTH SRVS Inc

Other organizations with this tax ID 8

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": "1241395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322611200000",
    "number": "1275767485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2555 N MARTIN LUTHER KING DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532122709",
            "telephone_number": "414-372-8080",
            "fax_number": "414-372-7425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4061 N 54TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532161377",
            "telephone_number": "414-372-8080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MHS CONVENIENT CARE CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILWAUKEE HEALTH SERVICES, INC",
        "enumeration_date": "2009-05-04",
        "last_updated": "2011-11-30",
        "status": "A",
        "authorized_official_last_name": "BOLDEN",
        "authorized_official_first_name": "FRAN",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "414-372-8080"
    },
    "taxonomies": [
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "WI",
            "license": "6282-800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE USG#",
            "identifier": "521804",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32831100",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33780500",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33724600",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33782900",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42183000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE UGS#",
            "identifier": "521829",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1518005818",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32958200",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43086700",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44066400",
            "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 Nov 30, 2011; 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.