City of Kenosha

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

6000422 Issued in WI

Legal business name

CITY OF KENOSHA

Doing business as

City of Kenosha Ambulance

Practice address

4810 60TH St
Kenosha, WI 53144-2451

Phone

(262) 653-4097

Fax

(262) 653-4107

NPI assigned

Jan 6, 2007

Last updated

Mar 17, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

CITY OF KENOSHAAs reported in NPPES

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

Authorized official

Name

Mr. James Poltrock

Title

Division Chief of EMS

Phone

(262) 653-4097

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• City of Kenosha Ambulance Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Part of

City of Kenosha

Locations

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

{
    "created_epoch": "1168041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1447308606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4810 60TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531442451",
            "telephone_number": "262-653-4097",
            "fax_number": "262-653-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4810 60TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531442451",
            "telephone_number": "262-653-4097",
            "fax_number": "262-653-4107"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "625 52nd St",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531403480",
            "country_code": "US",
            "telephone_number": "262-653-4100",
            "fax_number": "262-653-4107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CITY OF KENOSHA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CITY OF KENOSHA",
        "enumeration_date": "2007-01-06",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "POLTROCK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "DIVISION CHIEF OF EMS",
        "authorized_official_telephone_number": "262-653-4097",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WI",
            "license": "6000422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "590005740",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "City of Kenosha Ambulance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christopher Green LLC
• Verna F. Christy, PSYD
• Maryann Chrzaszcz, D.O.
• Michael James Church, PA-C
• Brian Patrick Chybowski, DDS
• Kathryn Clark, MSW, APSW
• Sarah J Clark, APNP
• John R Claussen, PA-C
• Edward Clay
• Clearsky Rehabilitation Hospital of Kenosha LLC

• Land Ambulance in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Land Ambulance in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.