| Kenosha Community Health Center, Inc. | |
|
930 Dr Martin Luther King Dr # 3 Racine WI 53404-3008 | |
| (262) 656-0044 | |
| (262) 764-3636 |
| Full Name | Kenosha Community Health Center, Inc. |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 930 Dr Martin Luther King Dr # 3, Racine, Wisconsin |
| Authorized Official Name and Position | John William Stampfl (CFO) |
| Authorized Official Contact | 2627713561 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenosha Community Health Center, Inc. 4006 Washington Rd Kenosha WI 53144-4819 Ph: (262) 771-3561 | Kenosha Community Health Center, Inc. 930 Dr Martin Luther King Dr # 3 Racine WI 53404-3008 Ph: (262) 656-0044 |
| NPI Number | 1215823406 |
|---|---|
| Provider Enumeration Date | 06/16/2025 |
| Last Update Date | 06/16/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215823406 | NPI | - | NPPES |
| 100328514 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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