NPIMap

Organization Active NPI

Muslim Community and Health Center of Wisconsin Inc

  • Community Health Clinic/Center
  • Milwaukee, WI
National Provider Identifier
1962850768
Registry record updated Nov 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
MUSLIM COMMUNITY AND HEALTH CENTER OF WISCONSIN INC
Practice address
803 W Layton Ave
Milwaukee, WI 53221-2426
Phone
(414) 939-4411
Fax
(414) 939-4466
NPI assigned
Jun 2, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2016

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

Authorized official

Name
Arman Tahir
Title
President
Phone
(414) 939-4411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

803 W Layton Ave
Milwaukee, WI 53221-2426

Mailing address

803 West Layton Ave
Milwaukee, WI 53221-2426
Phone (414) 939-4411

Other identifiers 1

IdentifierTypeStateIssuer
1962850768MedicaidWI

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20161227001392 WI Part B Supplier - Clinic/Group Practice 7618258062 Receives reassigned benefits from 39 practitioners
Practice locations: Milwaukee, WI
O20220923001538 WI Part A Provider - Federally Qualified Health Center (FQHC) 7618258062 Practice locations: Milwaukee, WI

Federally qualified health center certification: CCN 521000

Legal name
MUSLIM COMMUNITY AND HEALTH CENTER OF WISCONSIN INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 23, 2022
Last certification
Sep 23, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 13, 2012 in WI
Enrollment address
803 W Layton Ave
Milwaukee, WI 53221-2426

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2171166Muslim Community & Health Center of Wi, Inc803 West Layton Ave, Milwaukee, WI 53221Certificate of waiverAug 26, 2027

National Provider Directory

National Provider Directory

Locations

803 W Layton Ave
Milwaukee, WI 53221
Phone (414) 253-8330

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
Iqbal Ashraf Individual Corporate DirectorBoard Member Jan 1, 2004
Suhail Hameed Individual Corporate DirectorBoard Member Jan 1, 2004
Kauser Razvi Individual Corporate DirectorBoard Member Jan 1, 2004
Willie Perry Individual Corporate DirectorBoard Member Jan 1, 2004
Adel Bekhiet Individual Corporate DirectorBoard Member Jan 1, 2004
Farhat N Ashai-Khan Individual Corporate DirectorBoard Member Jan 1, 2004
Mohammed Khan Individual Corporate DirectorSecretary Jan 1, 2004
Arman Tahir Individual Corporate OfficerCeo Jan 1, 2004 5%
W-2 Managing EmployeeCeo Aug 1, 2022
Fozia Ahmed Individual Corporate OfficerPresident Jan 1, 2004
Rehan Khan Individual Corporate DirectorTreasurer Jan 1, 2004
Neelam Ayub Individual Corporate DirectorBoard Member Jan 1, 2004

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 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479168000000",
    "number": "1962850768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 WEST LAYTON AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532212426",
            "telephone_number": "414-939-4411",
            "fax_number": "414-939-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 W LAYTON AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532212426",
            "telephone_number": "414-939-4411",
            "fax_number": "414-939-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUSLIM COMMUNITY AND HEALTH CENTER OF WISCONSIN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-02",
        "last_updated": "2016-11-15",
        "status": "A",
        "authorized_official_last_name": "TAHIR",
        "authorized_official_first_name": "ARMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-939-4411"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962850768",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.