NPIMap

Organization Active NPI

Vivent Health Inc

  • Health Service Clinic/Center
  • Kenosha, WI
National Provider Identifier
1144513128
Registry record updated May 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
VIVENT HEALTH INC
Practice address
1212 57TH St
Kenosha, WI 53140-4069
Phone
(262) 657-6644
Fax
(262) 657-6949
NPI assigned
May 24, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Tim Dyer
Title
Exec VP
Phone
(866) 525-5484

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

1212 57TH St
Kenosha, WI 53140-4069

Mailing address

820 N Plankinton Ave
Milwaukee, WI 53203-1802
Phone (414) 225-1542

Other identifiers 1

IdentifierTypeStateIssuer
32895000MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
AIDS Resource Ctr Wi in7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652313600000",
    "number": "1144513128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 N PLANKINTON AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532031802",
            "telephone_number": "414-225-1542",
            "fax_number": "414-225-1575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 57TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531404069",
            "telephone_number": "262-657-6644",
            "fax_number": "262-657-6949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVENT HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-24",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "status": "A",
        "authorized_official_last_name": "DYER",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "EXEC VP",
        "authorized_official_telephone_number": "866-525-5484",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32895000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.