FROEDTERT SOUTH, INC. (NPI# 1558305284) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558305284 |
| Entity Type | Organization |
| Organization Name | FROEDTERT SOUTH, INC. |
| Other Organization Name | FROEDTERT SOUTH MEDICAL GROUP |
| Practice Address |
6308 8th Ave Kenosha WI 53143 |
| Mailing Address |
Po Box 130 Kenosha WI 53141-0130 |
| Practice Telephone | 2626562718 |
| Mailing Telephone | 2626562930 |
| Mailing Fax Number | 2626562749 |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2018-01-03 |
| Authorized Official Name | MR. THOMAS J KELLEY III (VICE PRESIDENT & CFO) |
| Authorized Official Telephone | 2625778113 |
| Is Organization Subpart | Y |
| Parent Organization Name | FROEDTERT SOUTH, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities | ||
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE | 213742 | 01 |
| WI | MEDICARE RR | CR0320 | 01 |
| WI | 32815500 | 05 |
| Other Name | Type Code |
|---|---|
| Froedtert South Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003831132 | Froedtert South, Inc. | Clinic/Center | 6308 8th Ave, Kenosha, WI 53143-5031 | 2006-07-12 |
| Street Address |
6308 8TH AVE |
| City | KENOSHA |
| State | WI |
| Zip Code | 53143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366440851 | Janet S Barney | Nurse Practitioner | 6308 8th Ave, Suite 2000, Kenosha, WI 53143-5031 | 2005-07-08 |
| 1669094165 | Simona Slavinskiene | Nurse Practitioner | 6308 8th Ave, Kenosha, WI 53143-5031 | 2020-05-07 |
| 1366063133 | Lisa Neyens | Pharmacist | 6308 8th Ave, Kenosha, WI 53143-5031 | 2020-05-02 |
| 1164056727 | Michael James Church | Physician Assistant | 6308 8th Ave, Kenosha, WI 53143-5031 | 2020-02-23 |
| 1215593009 | Ihc-wound Care Services LLC | Emergency Medicine | 6308 8th Ave, Kenosha, WI 53143-5031 | 2019-05-16 |
| 1609358357 | Samantha M Rhodes | Physical Therapist | 6308 8th Ave, Kenosha, WI 53143-5031 | 2018-08-29 |
| 1063953784 | Megan Roethle | Registered Nurse | 6308 8th Ave, Kenosha, WI 53143-5031 | 2017-03-14 |
| 1043678683 | Sarah Rens | Physician Assistant | 6308 8th Ave, Kenosha, WI 53143-5031 | 2016-02-09 |
| 1922472422 | Catherine A Hernandez | Physician Assistant | 6308 8th Ave, Kenosha, WI 53143-5031 | 2015-11-20 |
| 1750779856 | Elliot M Simon | Physician Assistant | 6308 8th Ave, Suite 1020, Kenosha, WI 53143-5031 | 2014-12-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891262275 | Shanda L Goecks | Registered Nurse | 6916 26th Ave, Kenosha, WI 53143 | 2018-10-24 |
| 1689942989 | Racine Kenosha Community Action Agency | Public Health or Welfare | 2000 63rd Street, Kenosha, WI 53143 | 2011-12-01 |
| 1538497797 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 7525 Sheridan Rd, Kenosha, WI 53143 | 2009-11-30 |
| 1497929012 | Ebba M Johnson | Physical Therapist | 524 74th Street, Kenosha, WI 53143 | 2008-04-15 |
| 1770789489 | Kenosha Community Health Center, Inc | Family Medicine | 6226 14th Ave, Kenosha, WI 53143 | 2007-06-21 |
| 1558413161 | Junith M Thompson | Obstetrics & Gynecology | 6530 Sheridan Road, Kenosha, WI 53143 | 2007-01-17 |
| 1154471332 | Ljh Ambulance, Inc | Ambulance | 6329 28th Ave, Kenosha, WI 53143 | 2007-01-11 |
| 1578625794 | Michael A Schellpfeffer Md Ob Gyn Sc | Obstetrics & Gynecology | 1400 75th Street, Kenosha, WI 53143 | 2006-12-14 |
| 1457468654 | Yasmine S Sido | Physician Assistant | 7550 22nd Ave, Kenosha, WI 53143 | 2006-08-24 |
| 1356307359 | Nancy Jane Houtchens | Dentist | 7533 22nd Ave, Ste 100, Kenosha, WI 53143 | 2006-04-26 |
| Find all providers in zip 53143 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.