| Pillar Health | |
|
6226 14th Ave Kenosha WI 53143 | |
| (262) 925-1350 | |
| (262) 653-2218 |
| Full Name | Pillar Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 6226 14th Ave, Kenosha, Wisconsin |
| Authorized Official Name and Position | Jack A Waters (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2622372850 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pillar Health 625 57th St Kenosha WI 53140-4146 Ph: (262) 764-3625 | Pillar Health 6226 14th Ave Kenosha WI 53143 Ph: (262) 925-1350 |
| NPI Number | 1770789489 |
|---|---|
| Provider Enumeration Date | 06/21/2007 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 0941195168 |
|---|---|
| Medicare Enrollment ID | O20090212000224 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770789489 | NPI | - | NPPES |
| 44014100 | Medicaid | WI | |
| 32956300 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Wisconsin) | Primary |
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