NPIMap

Organization Active NPI

Milwaukee Health Services Inc

Doing business as Isaac Coggs Heritage Health Center

  • Pharmacy
  • Milwaukee, WI
National Provider Identifier
1891732244
Registry record updated Apr 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
8664-42 Issued in WI
Legal business name
MILWAUKEE HEALTH SERVICES INC
Doing business as
Isaac Coggs Heritage Health Center
Practice address
8200 W Silver Spring Dr
Attention: Tito Izard, M.D.
Milwaukee, WI 53218-2552
Phone
(414) 267-2021
Fax
(414) 372-7420
NPI assigned
Jun 1, 2006
Last updated
Apr 5, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2016

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.
Title
President Ceo
Phone
(414) 267-2021

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X N/A
Pharmacy 333600000X 8664-42 WI Primary

Addresses

Primary practice location

8200 W Silver Spring Dr
Attention: Tito Izard, M.D.
Milwaukee, WI 53218-2552

Mailing address

2555 N Martin Luther King Dr
Milwaukee, WI 53212-2709
Phone (414) 267-2021

Other identifiers 2

IdentifierTypeStateIssuer
32958200MedicaidWI
36229500MedicaidWI

Other names 1

  • Isaac Coggs 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
O20040511000114 WI Part B Supplier - Clinic/Group Practice 7416946884 Receives reassigned benefits from 97 practitioners
5 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
Practice locations: Milwaukee, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891732244. Details of each certification follow.

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 with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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.

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Tito L Izard Individual Corporate OfficerPresident and Ceo Jan 17, 2006
W-2 Managing EmployeePresident and Ceo Jan 17, 2006 100%
Walter John Lanier Individual Corporate OfficerBoard Chairman May 25, 2018
Audrey Y Sellers Individual Corporate OfficerBoard Treasurer Sep 1, 2013
Antoinette Denise Herron Individual W-2 Managing Employee Jun 3, 2019
Karen Baker Individual Corporate OfficerBoard Secretary Sep 1, 2013
Laurie Yake Individual W-2 Managing EmployeeCfo May 1, 2019
Bridgett R Moss Individual Corporate OfficerVice Chairman May 25, 2018
Curtis E Harris Individual Corporate OfficerBoard Member Sep 1, 2013
Jaddia Arnold Individual Corporate OfficerBoard Secretary Jan 1, 2018
Gina L Green 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 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459814400000",
    "number": "1891732244",
    "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": "414-267-2021",
            "fax_number": "414-372-7420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8200 W SILVER SPRING DR",
            "address_2": "ATTENTION: TITO IZARD, M.D.",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532182552",
            "telephone_number": "414-267-2021",
            "fax_number": "414-372-7420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILWAUKEE HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2016-04-05",
        "status": "A",
        "authorized_official_last_name": "IZARD",
        "authorized_official_first_name": "TITO",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "414-267-2021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": "N/A",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WI",
            "license": "8664-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32958200",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36229500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Isaac Coggs Heritage Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.