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General NPI Number Information
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NPI Number | 1770789489
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Entity Type | Organization
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Legal Business Name | KENOSHA COMMUNITY HEALTH CENTER, INC
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 6226 14TH AVE
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City | KENOSHA
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State | WI
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Zip | 53143
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Country | US
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Telephone | 262-925-1350
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Fax | 262-653-2218
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Provider Business Mailing Address
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Address Line | 4006 WASHINGTON RD
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City | KENOSHA
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State | WI
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Zip | 53144-4819
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Country | US
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Telephone | 262-771-3558
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Fax | 262-649-1977
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Authorized Official
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Title or Position | CFO
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Name | JOHN WILLIAM STAMPFL
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Credential |
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Telephone | 262-771-3561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | WI
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