| Isaac Coggs Heritage Health Center | |
|
8200 W Silver Spring Dr Attention: Tito Izard, M.d. Milwaukee WI 53218-2552 | |
| (414) 267-2021 | |
| (414) 372-7420 |
| Full Name | Isaac Coggs Heritage Health Center |
|---|---|
| Speciality | Pharmacy |
| Location | 8200 W Silver Spring Dr, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Tito L Izard (PRESIDENT CEO) |
| Authorized Official Contact | 4142672021 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Isaac Coggs Heritage Health Center 2555 N Martin Luther King Dr Milwaukee WI 53212-2709 Ph: (414) 267-2021 | Isaac Coggs Heritage Health Center 8200 W Silver Spring Dr Attention: Tito Izard, M.d. Milwaukee WI 53218-2552 Ph: (414) 267-2021 |
| NPI Number | 1891732244 |
|---|---|
| Provider Enumeration Date | 06/01/2006 |
| Last Update Date | 04/05/2016 |
| Medicare PECOS PAC ID | 7416946884 |
|---|---|
| Medicare Enrollment ID | O20060823000618 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891732244 | NPI | - | NPPES |
| 36229500 | Medicaid | WI | |
| 32958200 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | N/A (* (Not Available)) | Secondary |
| 333600000X | Pharmacy | 8664-42 (Wisconsin) | Primary |
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