| Kenosha Community Health Center, Inc. | |
|
4536 22nd Ave Kenosha WI 53140-5917 | |
| (262) 656-0044 | |
| (262) 653-2218 |
| Full Name | Kenosha Community Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 4536 22nd Ave, Kenosha, Wisconsin |
| Authorized Official Name and Position | Mary Coffey (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2627643608 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenosha Community Health Center, Inc. 625 57th St Suite 700 Kenosha WI 53140-4146 Ph: (262) 764-3622 | Kenosha Community Health Center, Inc. 4536 22nd Ave Kenosha WI 53140-5917 Ph: (262) 656-0044 |
| NPI Number | 1265435960 |
|---|---|
| Provider Enumeration Date | 05/27/2005 |
| Last Update Date | 09/09/2014 |
| Medicare PECOS PAC ID | 0941195168 |
|---|---|
| Medicare Enrollment ID | O20040217000840 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265435960 | NPI | - | NPPES |
| 32956300 | Medicaid | WI |
| Provider Name | Manuel A Rivera |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1184690133 PECOS PAC ID: 0749251874 Enrollment ID: I20040803000977 |
| Provider Name | Abdul G Durrani |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1306833686 PECOS PAC ID: 2860384807 Enrollment ID: I20040821000100 |
| Provider Name | Bharathi Pulla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962559302 PECOS PAC ID: 6800864703 Enrollment ID: I20040920000129 |
| Provider Name | Matthew Mccarthy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306917570 PECOS PAC ID: 9234122201 Enrollment ID: I20061220000163 |
| Provider Name | Karla S Boho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659301653 PECOS PAC ID: 0547364077 Enrollment ID: I20070322000420 |
| Provider Name | Sharee Lanee Chance-lawson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659498822 PECOS PAC ID: 2365406014 Enrollment ID: I20071112000298 |
| Provider Name | Heidi E Eckelberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427367184 PECOS PAC ID: 2163604927 Enrollment ID: I20110315000919 |
| Provider Name | Clare Lewandowski |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407207764 PECOS PAC ID: 2961798988 Enrollment ID: I20160831000196 |
| Provider Name | Timothy A Sanborn |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1073600987 PECOS PAC ID: 2961458872 Enrollment ID: I20180618002972 |
| Provider Name | Codie Vassar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538690995 PECOS PAC ID: 5496009565 Enrollment ID: I20181109000024 |
| Provider Name | Krystal M Rafenstein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336798685 PECOS PAC ID: 7618301888 Enrollment ID: I20191220000963 |
| Provider Name | Suzanne M Girard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578196770 PECOS PAC ID: 6608204110 Enrollment ID: I20200317000461 |
| Provider Name | Bruno A Knopp |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1558344325 PECOS PAC ID: 3678818440 Enrollment ID: I20210409001649 |
| Provider Name | Tambra R Daniels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376012070 PECOS PAC ID: 6608278692 Enrollment ID: I20210714000020 |
| Provider Name | Jenell D Jackley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942502612 PECOS PAC ID: 3577929009 Enrollment ID: I20230525001181 |
| Provider Name | Reed J Neuman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407454572 PECOS PAC ID: 5890154710 Enrollment ID: I20230710001979 |
| Provider Name | Vedrana Jovkovic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174301899 PECOS PAC ID: 2062861859 Enrollment ID: I20231205002099 |
| Provider Name | Tracy L Margetson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720845860 PECOS PAC ID: 6507205788 Enrollment ID: I20240422000084 |
| Provider Name | Jennifer L Eppinger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629826425 PECOS PAC ID: 0143765214 Enrollment ID: I20240712002148 |
| Provider Name | John Rocha |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962912287 PECOS PAC ID: 3779841036 Enrollment ID: I20241016003198 |
| Provider Name | Amy R Crum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295579951 PECOS PAC ID: 6103358023 Enrollment ID: I20241017000213 |
| Provider Name | Cassandra N Gillen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245058130 PECOS PAC ID: 1052844867 Enrollment ID: I20241101000248 |
Riley & Armstrong D.d.s., S.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 7910 39th Ave, Kenosha, WI 53142 Phone: 262-694-7672 Fax: 262-694-7110 | |
Kenosha Family Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5707 75th St, Kenosha, WI 53142 Phone: 262-697-0321 | |
Gregory A. Santarelli Dds Sc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5017 Green Bay Rd Ste 138, Kenosha, WI 53144 Phone: 262-654-6770 Fax: 262-654-6727 | |
Bruce F Andrekus, Dds,sc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3726 Roosevelt Rd, Kenosha, WI 53142 Phone: 262-652-7956 |