KENOSHA COMMUNITY HEALTH CENTER, INC (NPI# 1770789489) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770789489 |
| Entity Type | Organization |
| Organization Name | KENOSHA COMMUNITY HEALTH CENTER, INC |
| Practice Address |
6226 14th Ave Kenosha WI 53143 |
| Mailing Address |
625 57th St Kenosha WI 53140-4146 |
| Practice Telephone | 2629251350 |
| Practice Fax Number | 2626532218 |
| Mailing Telephone | 2627643625 |
| Mailing Fax Number | 2627643636 |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2011-12-06 |
| Authorized Official Name | MR. JACK A WATERS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2622372850 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
========= | WI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 32956300 | 05 | |
| WI | 44014100 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568931541 | Kenosha Community Health Center, Inc | Clinic/Center | 903 S 2nd St, Silver Lake, WI 53170-1747 | 2018-11-19 |
| Street Address |
6226 14TH AVE |
| City | KENOSHA |
| State | WI |
| Zip Code | 53143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609424837 | Heather Nicole Matejka | Dentist | 6226 14th Ave, Kenosha, WI 53143-4413 | 2019-08-30 |
| 1801454269 | Connie Lee Bevry | Dental Hygienist | 6226 14th Ave, Kenosha, WI 53143-4413 | 2019-05-31 |
| 1841773793 | Donna M Zagame | Dental Hygienist | 6226 14th Ave, Kenosha, WI 53143-4413 | 2018-09-06 |
| 1033649850 | Melissa Lynn Davis | Dentist | 6226 14th Ave, Kenosha, WI 53143-4413 | 2017-06-14 |
| 1043657158 | Tarah Marie Gerner | Dentist | 6226 14th Ave, Kenosha, WI 53143-4413 | 2013-05-30 |
| 1467715474 | Craig A. Peterson | Dentist | 6226 14th Ave, Kenosha, WI 53143-4413 | 2012-06-25 |
| 1457620031 | Mark Rehorst | Dentist | 6226 14th Ave, Kenosha, WI 53143-4413 | 2011-12-28 |
| 1962788596 | Robyn L. Bednarek | Dental Hygienist | 6226 14th Ave, Suite 700, Kenosha, WI 53143-4413 | 2011-10-27 |
| 1235415993 | Delores Chovan | Dental Hygienist | 6226 14th Ave, Kenosha, WI 53143-4413 | 2011-10-26 |
| 1225312473 | Dara T Brady | Dental Hygienist | 6226 14th Ave, Kenosha, WI 53143-4413 | 2011-10-06 |
| 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 |
| 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 |
| 1871566257 | Terry W Huff Dds Sc | Clinic/Center | 6402 Sheridan Rd, Kenosha, WI 53143 | 2006-02-08 |
| Find all providers in zip 53143 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942595657 | Kenosha Community Health Center, Inc. | Clinic/Center | 1330 52nd St, Suite 205, Kenosha, WI 53140-3236 | 2011-06-10 |
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| 1326693847 | Scenic Bluffs Health Center, Inc | Clinic/Center | 100 Blackhawk Dr, Viroqua, WI 54665-1315 | 2019-08-02 |
| 1942718762 | Sixteenth Street Community Health Centers, Inc. | Clinic/Center | 2607 S 5th St, Milwaukee, WI 53207-1418 | 2018-01-15 |
| 1659884716 | The Lakes Community Health Center, Inc | Clinic/Center | 15954 Rivers Edge Dr Ste 304, Hayward, WI 54843-7800 | 2017-11-13 |
| 1275056632 | Outreach Community Health Centers, Inc. | Clinic/Center | 9120 W Hampton Ave Ste 119, Milwaukee, WI 53225-4960 | 2017-07-18 |
| 1437695038 | Scenic Bluffs Health Center, Inc. | Clinic/Center | 200 West North Street, Norwalk, WI 54648 | 2017-01-06 |
| 1841742673 | The Lakes Community Health Center, Inc | Clinic/Center | 300 Main Street West, Ashland, WI 54806-3696 | 2016-10-27 |
| 1174071658 | Kenosha Community Health Center, Inc. | Clinic/Center | 2310 Center St, Racine, WI 53403-3330 | 2016-09-14 |
| 1841652021 | Scenic Bluffs Health Center, Inc. | Clinic/Center | 201 E Franklin St Rm B3, Sparta, WI 54656-1803 | 2016-03-25 |
| 1366844003 | Scenic Bluffs Health Center, Inc | Clinic/Center | 201 E Franklin St # B3, Sparta, WI 54656-1803 | 2014-09-25 |
| 1679983423 | The Lakes Community Health Center, Inc | Clinic/Center | 524 Bissell Street, White Lake, WI 54491 | 2014-05-02 |
| Find all providers with the same taxonomy | ||||
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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.