Kenosha Pain Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

KENOSHA PAIN CENTER LLC

Practice address

6123 Green Bay Rd Ste 100
Kenosha, WI 53142-2939

Phone

(262) 297-7246

NPI assigned

Apr 26, 2021

Last updated

May 4, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Karen M Bewer, RN BSN

Title

Administrator

Phone

(262) 297-7246

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1619395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620086400000",
    "number": "1508448853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 W LAYTON AVE STE 200",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532215434",
            "telephone_number": "262-297-7246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6123 GREEN BAY RD STE 100",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422939",
            "telephone_number": "262-297-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENOSHA PAIN CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-26",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A",
        "authorized_official_last_name": "BEWER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "262-297-7246",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN BSN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Kenosha",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "6123 Green Bay Rd Ste 100",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531422939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kenosha Hearing Aid Centers
• Kenosha Human Development Services, Inc
• Kenosha Human Development Services, Inc
• Kenosha Kidney Dialysis LLC
• Kenosha Oral Surgery, S.C.
• Kenosha Pathology Consultants
• Kenosha Radiology Center LLC.
• Kenosha Senior Living, Inc. (Kenosha Senior Living)
• Kenosha Shuttle LLC
• Kenosha Surgicenter LLC

• Ambulatory Surgical Clinic/Center in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Ambulatory Surgical Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2021; 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.