Organization
PROGRESSIVE COMMUNITY HEALTH CENTERS, INC.
Active
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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