Organization
PROGRESSIVE COMMUNITY HEALTH CENTERS, INC.
Active
Other names
Lisbon Avenue Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
CANDICE COLE (CFO)
(414) 935-8000
Entity
Organization
Contact information
Practice address
3522 W LISBON AVE, MILWAUKEE, WI 53208-1953
(414) 935-8000
(414) 344-3396
Mailing address
PO BOX 080257, MILWAUKEE, WI 53208-8004
(414) 935-8000
(414) 755-0058
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
122300000X
Dentist
—
—
124Q00000X
Dental Hygienist
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32957400
—
WI
Enumeration date
11/24/2006
Last updated
01/25/2017
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