NPIMap

Organization Active NPI

Milwaukee Health Services Inc

Doing business as Martin Luther King Heritage Health Center

  • Case Management Agency
  • Milwaukee, WI
National Provider Identifier
1346657442
Registry record updated Jul 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
License
102001-30 Issued in WI
Legal business name
MILWAUKEE HEALTH SERVICES INC
Doing business as
Martin Luther King Heritage Health Center
Practice address
2555 N Martin Luther King Dr
Milwaukee, WI 53212-2709
Phone
(414) 267-2022
Fax
(414) 372-7420
NPI assigned
Jul 21, 2014
Last updated
Jul 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2014

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

Authorized official

Name
Dr. Tito L Izard, M.D.NPI 1013947662
Title
President/Chief Executive Officer
Phone
(414) 267-2022

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 72014-30 WI
Case Management Agency 251B00000X 102001-30 WI Primary

Addresses

Primary practice location

2555 N Martin Luther King Dr
Milwaukee, WI 53212-2709

Mailing address

2555 N Martin Luther King Dr
Milwaukee, WI 53212-2709
Phone (414) 267-2022

Other identifiers 1

IdentifierTypeStateIssuer
000002690OtherWIMEDICARE PTAN

Other names 1

  • Martin Luther King Heritage Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060823000610 WI Part A Provider - Federally Qualified Health Center (FQHC) 7416946884 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Milwaukee, WI
O20060823000618 WI Part A Provider - Federally Qualified Health Center (FQHC) 7416946884 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Milwaukee, WI

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1346657442. Details of each certification follow.

Federally qualified health center certification: CCN 521829

Legal name
MILWAUKEE HEALTH SERVICES, INC.
Doing business as
MARTIN LUTHER KING HERITAGE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 12, 2006
Last certification
Oct 12, 2006
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 27, 1989 in WI
Enrollment address
2555 N Martin Luther King Dr
Milwaukee, WI 53212-2709

Federally qualified health center certification: CCN 521804

Legal name
MILWAUKEE HEALTH SERVICES, INC.
Doing business as
ISAAC COGGS HERITAGE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 27, 1989 in WI
Enrollment address
8200 W Silver Spring Dr
Milwaukee, WI 53218-2552

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
MHS Convenient Care Clinic9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

4061 N 54th St
Milwaukee, WI 53216
Phone (414) 447-1750

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Paula a Lucey Individual Corporate Director May 25, 2018
Tito L Izard Individual Corporate OfficerPresident and Ceo May 1, 2011
W-2 Managing EmployeePresident and Ceo May 1, 2019
Corporate OfficerPresident and Ceo Jan 17, 2006
W-2 Managing EmployeePresident and Ceo Jan 17, 2006 100%
Walter John Lanier Individual Corporate DirectorBoard Member May 25, 2018
Corporate OfficerBoard Chairman May 25, 2018
Audrey Y Sellers Individual Corporate Director Nov 1, 2002
Corporate OfficerBoard Treasurer Sep 1, 2013
Antoinette Denise Herron Individual W-2 Managing Employee Jun 3, 2019
Karen Baker Individual Corporate Director Nov 1, 2002
Corporate OfficerBoard Secretary Sep 1, 2013
Laurie Yake Individual Corporate OfficerCfo May 1, 2019
W-2 Managing EmployeeCfo May 1, 2019
Bridgett R Moss Individual Corporate OfficerBoard Member May 25, 2018
Corporate OfficerVice Chairman May 25, 2018
Jaddia Arnold Individual Corporate Director May 25, 2018
Corporate OfficerBoard Secretary Jan 1, 2018
Gina L Green Harris Individual Corporate Director May 25, 2018
Corporate OfficerBoard Member Sep 1, 2013
Curtis E Harris Individual Corporate OfficerBoard Member Sep 1, 2013

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 96

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.

View all 96

NPI Registry JSON

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

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405900800000",
    "number": "1346657442",
    "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": "414-267-2022",
            "fax_number": "414-372-7420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 N MARTIN LUTHER KING DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532122709",
            "telephone_number": "414-267-2022",
            "fax_number": "414-372-7420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILWAUKEE HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-21",
        "last_updated": "2014-07-21",
        "status": "A",
        "authorized_official_last_name": "IZARD",
        "authorized_official_first_name": "TITO",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT/CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "414-267-2022",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "WI",
            "license": "72014-30",
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "WI",
            "license": "102001-30",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "000002690",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martin Luther King Heritage Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.