| Southport Healthcare Llc | |
|
600 52nd St Ste 300 Kenosha WI 53140-3423 | |
| (262) 656-8400 | |
| Not Available |
| Full Name | Southport Healthcare Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 600 52nd St Ste 300, Kenosha, Wisconsin |
| Authorized Official Name and Position | Amber L Tueller (SECRETARY) |
| Authorized Official Contact | 2082072726 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southport Healthcare Llc 600 52nd St Ste 300 Kenosha WI 53140-3423 Ph: (262) 656-8400 | Southport Healthcare Llc 600 52nd St Ste 300 Kenosha WI 53140-3423 Ph: (262) 656-8400 |
| NPI Number | 1740906874 |
|---|---|
| Provider Enumeration Date | 10/19/2022 |
| Last Update Date | 06/06/2025 |
| Medicare PECOS PAC ID | 3678941531 |
|---|---|
| Medicare Enrollment ID | O20221130000174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740906874 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
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Gevinah Healthcare Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3100 Washington Rd, Kenosha, WI 53144 Phone: 310-933-5688 | |
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