Healthcare Provider Details

I. General information

NPI: 1467643130
Provider Name (Legal Business Name): KENOSHA COUNTY DIVISION OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/27/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 SHERIDAN RD SUITE 600
KENOSHA WI
53143-6506
US

IV. Provider business mailing address

8600 SHERIDAN RD SUITE 600
KENOSHA WI
53143-6506
US

V. Phone/Fax

Practice location:
  • Phone: 262-605-6700
  • Fax: 262-605-6715
Mailing address:
  • Phone: 262-605-6700
  • Fax: 262-605-6715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JOHN JANSEN
Title or Position: DIRECTOR
Credential:
Phone: 262-605-6700