Organization
MHS CONVENIENT CARE CLINIC
Active
Parent organization
MILWAUKEE HEALTH SERVICES, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MILWAUKEE HEALTH SERVICES, INC
Authorized official
FRAN BOLDEN (CREDENTIALING COORDINATOR)
(414) 372-8080
Entity
Organization
Contact information
Practice address
4061 N 54TH ST, MILWAUKEE, WI 53216-1377
(414) 372-8080
Mailing address
2555 N MARTIN LUTHER KING DR, MILWAUKEE, WI 53212-2709
(414) 372-8080
(414) 372-7425
Taxonomy
Speciality
Code
Description
License number
State
363LC1500X
Community Health Nurse Practitioner
Primary
6282-800
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518005818
—
WI
05
—
32831100
—
WI
05
—
32958200
—
WI
05
—
33724600
—
WI
05
—
33780500
—
WI
05
—
33782900
—
WI
05
—
42183000
—
WI
05
—
43086700
—
WI
05
—
44066400
—
WI
01
—
521804
MEDICARE USG#
WI
01
—
521829
MEDICARE UGS#
WI
Enumeration date
05/04/2009
Last updated
11/30/2011
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