Provider Demographics
NPI:1871795690
Name:CITY OF SOUTH MILWAUKEE
Entity type:Organization
Organization Name:CITY OF SOUTH MILWAUKEE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:OVE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:414-768-8055
Mailing Address - Street 1:2424 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-2410
Mailing Address - Country:US
Mailing Address - Phone:414-768-8055
Mailing Address - Fax:414-768-5720
Practice Address - Street 1:2424 15TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-2410
Practice Address - Country:US
Practice Address - Phone:414-768-8055
Practice Address - Fax:414-768-5720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF SOUTH MILWAUKEE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-04
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251K00000X
261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251K00000XAgenciesPublic Health or Welfare