Kenosha County Div of Public Health

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

KENOSHA COUNTY DIV OF PUBLIC HEALTH

Practice address

8600 Sheridan Rd
Suite 600
Kenosha, WI 53143-6506

Phone

(262) 605-6700

Fax

(262) 605-6715

NPI assigned

Aug 5, 2007

Organization subpart

No

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

Authorized official

Name

Mr. John Jansen

Title

Director

Phone

(262) 605-6700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Public Health Laboratory Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 4

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

• Mary Mainland, M.D.

  • Laboratory Management Specialist/Technologist
  • Kenosha, WI
  • NPI 1659543494
  NPD (past)
• Gwendolyn M Perry-Brye, RNC, MS, WHNP

  • Nurse Practitioner
  • Kenosha, WI
  • NPI 1568459568
  NPD (past)
• Elizabeth Mary Timm Smith, FNP

  • Family Nurse Practitioner
  • Kenosha, WI
  • NPI 1922473578
  NPD (past)
• Mark Witeck, M.D.

  • Laboratory Management Specialist/Technologist
  • Kenosha, WI
  • NPI 1811146897
  NPD (past)

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1477744472",
    "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 DIV OF PUBLIC HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-05",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32924500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Public Health Laboratory",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Public Health Laboratory",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kenosha County Department of Human Services
• Kenosha County Department of Human Services
• Kenosha County Department of Human Services
• Kenosha County Department of Human Services
• Kenosha County Department of Human Services
• Kenosha County Division of Health
• Kenosha County Scout Leaders Rescue Squad, Inc (Scout Leaders Rescue Squad, Inc)
• Kenosha Dentist LLC
• Kenosha Digestive Health Center LLC
• Kenosha Emergency Physicians, LLC

• Clinical Medical Laboratory in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Clinical Medical Laboratory in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.