Provider Demographics
NPI:1467643130
Name:KENOSHA COUNTY DIVISION OF HEALTH
Entity type:Organization
Organization Name:KENOSHA COUNTY DIVISION OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-605-6700
Mailing Address - Street 1:8600 SHERIDAN RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-6506
Mailing Address - Country:US
Mailing Address - Phone:262-605-6700
Mailing Address - Fax:262-605-6715
Practice Address - Street 1:8600 SHERIDAN RD
Practice Address - Street 2:SUITE 600
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-6506
Practice Address - Country:US
Practice Address - Phone:262-605-6700
Practice Address - Fax:262-605-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X, 291U00000X, 251B00000X, 261QF0050X
WI251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
No251B00000XAgenciesCase Management
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41862400Medicaid
WI42010200Medicaid
WI44000000Medicaid
WI43084000Medicaid
000081711Medicare PIN