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PROVIDENCE FAMILY MEDICAL CLINIC S.C
NPI 1861857542
Clinic/Center - Primary Care in Glendale, WI

Active since December 22, 2015CLIA 52D2108037 · Waiver
2500 W SILVER SPRING DR, GLENDALE, WI 53209(414) 800-7171(414) 800-7166 Get Directions Write a Review

NPPES record last updated: December 22, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Providence Family Medical Clinic S.c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE FAMILY MEDICAL CLINIC S.C (NPI 1861857542) is a healthcare organization registered as a primary care in Glendale, Wisconsin and active in the NPI registry since December 2015. The organization holds a CLIA Waiver certificate valid through January 26, 2028 and lists Adedapo F Okusanya, President, as its authorized official.

NPPES Registry Identity

NPI1861857542
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NamePROVIDENCE FAMILY MEDICAL CLINIC S.C
Location Address2500 W SILVER SPRING DRGlendale, WI 53209-4218
Mailing Address2500 W Silver Spring DrGlendale, WI 53209-4218 · (414) 800-7171 · Fax (414) 800-7166
Phone(414) 800-7171
Fax(414) 800-7166
Organization SubpartNo
Authorized OfficialAdedapo F OkusanyaPresident · (269) 598-7404
Enumeration DateDecember 22, 2015
✔ NPI 1861857542 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
2500 W SILVER SPRING DR, Glendale, WI 53209
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D2108037

Providence Family Medical Clinic, Sc · Glendale, WI
Active · expires Jan 26, 2028
CLIA Number52D2108037
Laboratory TypePhysician Office
Certificate Effective DateJanuary 27, 2026
Certificate Expiration DateJanuary 26, 2028
Laboratory DirectorDr. Adedapo F. Okusanya
Laboratory Phone(414) 800-7171
Laboratory LocationProvidence Family Medical Clinic, Sc2500 W Silver Spring Dr, Glendale, WI 53209
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHILDREN'S MEDICAL GROUP
Pediatrics
2500 W SILVER SPRING DR, SUITE C
GLENDALE, WI 53209
Milwaukee County (414) 393-1925
PROVIDENCE PHARMACY & WELLNESS
Pharmacy
2500 W SILVER SPRING DR
GLENDALE, WI 53209
Milwaukee County (414) 400-0104
OLALEKAN LUKMAN GANIYU PT, MHSC, MTC
Clinic/Center (Physical Therapy)
2500 W SILVER SPRING DR, STE A
GLENDALE, WI 53209
Milwaukee County (608) 368-9783
PROVIDENCE FAMILY PHARMACY LLC
Pharmacy (Community/Retail Pharmacy)
2500 W SILVER SPRING DR
GLENDALE, WI 53209
Milwaukee County (414) 885-0550
DR. ANDREW ALAN LIJEWSKI D.C.
Chiropractor
2500 W SILVER SPRING DR
GLENDALE, WI 53209
Milwaukee County (414) 395-1279
MR. ADEDAPO F OKUSANYA MD
Family Medicine
2500 W SILVER SPRING DR
GLENDALE, WI 53209
Milwaukee County (414) 800-7171
CARI BETH CROSBY PT
Physical Therapist
2500 W SILVER SPRING DR
MILWAUKEE, WI 53209
Milwaukee County (414) 007-1718

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Family Medical Clinic S.C's NPI number?

The NPI number for Providence Family Medical Clinic S.C is 1861857542. It was assigned to this organization in the NPPES registry on December 22, 2015.

Where is Providence Family Medical Clinic S.C located?

Providence Family Medical Clinic S.C is located at 2500 W Silver Spring Dr, Glendale, WI 53209. The listed phone number is (414) 800-7171.

What is Providence Family Medical Clinic S.C's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Providence Family Medical Clinic S.C hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D2108037) is associated with this NPI, valid through January 26, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Providence Family Medical Clinic S.C accept?

Health plans from Anthem Blue Cross and Blue Shield list Providence Family Medical Clinic S.C as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Providence Family Medical Clinic S.C was last updated on December 22, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.