| Kenosha Community Health Center, Inc | |
|
903 S 2nd St Silver Lake WI 53170-1747 | |
| (262) 656-0044 | |
| Not Available |
| Full Name | Kenosha Community Health Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 903 S 2nd St, Silver Lake, Wisconsin |
| Authorized Official Name and Position | Dorian Collins (CREDENTALING SPECIALIST) |
| Authorized Official Contact | 2627643622 |
| 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 Ste 700 Kenosha WI 53140-4146 Ph: (262) 764-3622 | Kenosha Community Health Center, Inc 903 S 2nd St Silver Lake WI 53170-1747 Ph: (262) 656-0044 |
| NPI Number | 1568931541 |
|---|---|
| Provider Enumeration Date | 11/19/2018 |
| Last Update Date | 11/19/2018 |
| Medicare PECOS PAC ID | 0941195168 |
|---|---|
| Medicare Enrollment ID | O20190213000346 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568931541 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |