NPIMap

Organization Active NPI

Kenosha County Division of Health

  • Public Health or Welfare Agency
  • Kenosha, WI
National Provider Identifier
1467643130
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
KENOSHA COUNTY DIVISION OF HEALTH
Practice address
8600 Sheridan Rd
Suite 600
Kenosha, WI 53143-6506
Phone
(262) 605-6700
Fax
(262) 605-6715
NPI assigned
Aug 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Authorized official

Name
John Jansen
Title
Director
Phone
(262) 605-6700

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Public Health or Welfare Agency 251K00000X WI Primary
Non-Surgical Family Planning Clinic/Center 261QF0050X
Primary Care Clinic/Center 261QP2300X
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

8600 Sheridan Rd
Suite 600
Kenosha, WI 53143-6506

Mailing address

8600 Sheridan Rd
Suite 600
Kenosha, WI 53143-6506
Phone (262) 605-6700

Other identifiers 4

IdentifierTypeStateIssuer
41862400MedicaidWI
42010200MedicaidWI
44000000MedicaidWI
43084000MedicaidWI

Other names 1

  • Kenosha County Health Dept Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041004000018 WI Part B Supplier - Mass Immunization (Roster Biller Only) 6305815689 Practice locations: Kenosha, WI

National Provider Directory

National Provider Directory
Tax ID family
Kenosha Cty Div HLTH la9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

8600 Sheridan Rd
Ste 600
Kenosha, WI 53143
Phone (262) 605-6700

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Brookside Care CenterKenosha, WI, CCN 525556 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Direct Ownership Interest (100%)		 Jul 12, 1995
Jul 12, 1995

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1467643130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 SHERIDAN RD",
            "address_2": "SUITE 600",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531436506",
            "telephone_number": "262-605-6700",
            "fax_number": "262-605-6715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 SHERIDAN RD",
            "address_2": "SUITE 600",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531436506",
            "telephone_number": "262-605-6700",
            "fax_number": "262-605-6715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENOSHA COUNTY DIVISION OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-07",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-26",
        "status": "A",
        "authorized_official_last_name": "JANSEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "262-605-6700"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "WI",
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41862400",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42010200",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44000000",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43084000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kenosha County Health Dept",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Kenosha County Health Dept",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.