NPIMap

Organization Active NPI

Ravenswood Clinic Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Milwaukee, WI
National Provider Identifier
1285716308
Registry record updated Mar 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
2118 Issued in WI
Legal business name
RAVENSWOOD CLINIC INC
Practice address
2266 N Prospect Ave
Suite 608
Milwaukee, WI 53202-6306
Phone
(414) 224-0492
Fax
(414) 224-8112
NPI assigned
Oct 19, 2006
Last updated
Mar 27, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2014

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

Authorized official

Name
Mr. Anthony Francis Werth Jr., MSNPI 1932205358
Title
Executive Director
Phone
(414) 224-0492

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 2118 WI Primary

Addresses

Primary practice location

2266 N Prospect Ave
Suite 608
Milwaukee, WI 53202-6306

Mailing address

2266 N Prospect Ave
Suite 326
Milwaukee, WI 53202-6306
Phone (414) 224-0492

Other identifiers 1

IdentifierTypeStateIssuer
L12215600MedicaidWI

Other names 1

  • Ravenswood Clinic Other name

National Provider Directory

National Provider Directory

Locations

2266 N Prospect Ave
Ste 326
Milwaukee, WI 53202
Phone (414) 224-0492

2266 N Prospect Ave
Ste 608
Milwaukee, WI 53202
Phone (414) 224-0492

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395878400000",
    "number": "1285716308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2266 N PROSPECT AVE",
            "address_2": "SUITE 326",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532026306",
            "telephone_number": "414-224-0492",
            "fax_number": "414-224-8112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2266 N PROSPECT AVE",
            "address_2": "SUITE 608",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532026306",
            "telephone_number": "414-224-0492",
            "fax_number": "414-224-8112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAVENSWOOD CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2014-03-27",
        "status": "A",
        "authorized_official_last_name": "WERTH",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "FRANCIS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "414-224-0492",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "2118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L12215600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ravenswood Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Mar 27, 2014; 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.