Kenosha Vascular Laboratory

Primary specialty

SpecialistTaxonomy code 174400000X

License

22193 Issued in WI

Legal business name

KENOSHA VASCULAR LABORATORY

Practice address

6308 8TH Ave Ste 301
Kenosha, WI 53143-5031

Phone

(262) 656-8265

NPI assigned

Sep 19, 2008

Last updated

Sep 19, 2008By 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

Rose M Techert

Title

Billing

Phone

(262) 656-8265

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1221782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221782400000",
    "number": "1922258540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6308 8TH AVE STE 301",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435031",
            "telephone_number": "262-656-8265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6308 8TH AVE STE 301",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435031",
            "telephone_number": "262-656-8265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENOSHA VASCULAR LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-19",
        "last_updated": "2008-09-19",
        "status": "A",
        "authorized_official_last_name": "TECHERT",
        "authorized_official_first_name": "ROSE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "262-656-8265"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WI",
            "license": "22193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "1376537993",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenosha Surgicenter LLC
• Kenosha Unified School District No. 1
• Kenosha Urgicare
• Kenosha Urology Clinic, S.C.
• Kenosha Vascular Lab Inc
• Kenosha Visiting Nurse Association, Inc.
• Steven Edward Kenzer, D.O.
• Lori J Kerber, DDS
• Rachel Ann Longawa Ketter, PA-C
• Alison M Ketterhagen, PA-C

• Specialist in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Specialist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2008; 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.