PAIN CENTERS OF WISCONSIN - KENOSHA, LLC (NPI# 1629631536) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629631536 |
| Entity Type | Organization |
| Organization Name | PAIN CENTERS OF WISCONSIN - KENOSHA, LLC |
| Practice Address |
9697 Saint Catherines Dr Ste 102 Kenosha WI 53158-2119 |
| Mailing Address |
4131 W Loomis Rd Ste 300 Greenfield WI 53221-2059 |
| Practice Telephone | 4143257246 |
| Practice Fax Number | 4143253770 |
| Mailing Telephone | 4143257246 |
| Mailing Fax Number | 4143253770 |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2019-04-16 |
| Authorized Official Name | VISHAL LAL (AUTHORIZED REPRESENTATIVE) |
| Authorized Official Telephone | 4143257246 |
| Is Organization Subpart | Y |
| Parent Organization Name | APM WISCONSIN MSO, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407152945 | Pain Centers of Wisconsin - Kenosha, LLC | Clinic/Center | 9697 Saint Catherines Dr, Ste 102, Pleasant Prairie, WI 53158-2118 | 2011-02-01 |
| Street Address |
9697 SAINT CATHERINES DR STE 102 |
| City | KENOSHA |
| State | WI |
| Zip Code | 53158-2119 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497393516 | Aurora Surgery Centers, LLC | Clinic/Center | 12500 Aurora Drive, Pleasant Prairie, WI 53158 | 2019-12-19 |
| 1770144297 | Jill Plaisted | Counselor | 8503 75th Street, Suite A, Pleasant Prairie, WI 53158 | 2019-06-25 |
| 1427593847 | Douglas Marion Mcdaniel | Physical Therapy Assistant | 5932 85th St, Pleasant Prairie, WI 53158 | 2016-12-20 |
| 1477095602 | Molly Weber | Speech-Language Pathologist | 8717 82nd St, Apartment 109, Pleasant Prairie, WI 53158 | 2016-11-04 |
| 1568919165 | Nicole Taylor | Specialist/Technologist | 9321 8th Avenue, Pleasant Prairie, WI 53158 | 2016-09-01 |
| 1578980165 | Forefront Dermatology, S.c. | Dermatology | 9020 76th St, Suite E, Pleasant Prairie, WI 53158 | 2014-03-21 |
| 1750603130 | Shelley L Johnson | Nurse Practitioner | 9697 Saint Catherines Dr # 300, Pleasant Prairie, WI 53158 | 2010-02-25 |
| 1194054981 | Jennifer S Stevens | Behavioral Analyst | 10450 72nd Ave, Pleasant Prairie, WI 53158 | 2009-12-08 |
| 1932273398 | Pamela Anderson | Registered Nurse | 11202 79 Street, Pleasant Prairie, WI 53158 | 2006-11-20 |
| 1033205562 | Holly Seidman | Pharmacist | 1309 110th Street, Pleasant Prairie, WI 53158 | 2006-10-04 |
| Find all providers in zip 53158 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114551165 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 3536 52nd St Ste P, Kenosha, WI 53144-2662 | 2020-02-28 |
| 1760910731 | Xibalba Technological Solutions, LLC | Durable Medical Equipment & Medical Supplies | 1409 Sheridan Rd, Kenosha, WI 53140-4443 | 2017-06-02 |
| 1497291116 | Gustavo Urbina | Durable Medical Equipment & Medical Supplies | 4623 75th St, Suite 279, Kenosha, WI 53142-3701 | 2017-01-19 |
| 1639564578 | Meijer Stores Limited Partnership | Durable Medical Equipment & Medical Supplies | 7701 Green Bay Rd, Kenosha, WI 53142-4043 | 2015-03-30 |
| 1124326764 | Wisconsin Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3710 57th Ave, Kenosha, WI 53144 | 2011-03-07 |
| 1912201534 | Livingwell Home Medical Supplies Inc | Durable Medical Equipment & Medical Supplies | 3921 30th Ave Ste B, Kenosha, WI 53144-1957 | 2010-12-23 |
| 1538497797 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 7525 Sheridan Rd, Kenosha, WI 53143 | 2009-11-30 |
| 1396970489 | Sams East Inc | Durable Medical Equipment & Medical Supplies | 3300 Brumback Blvd, Kenosha, WI 53144-4815 | 2009-05-19 |
| 1043444391 | Homestead Independence Inc | Durable Medical Equipment & Medical Supplies | 3203 Washington Rd, Suite G, Kenosha, WI 53144-1643 | 2009-05-14 |
| 1851598619 | Aurora Medical Group, Inc. | Durable Medical Equipment & Medical Supplies | 2707 15th Place, Kenosha, WI 53140 | 2007-06-27 |
| Find all providers in KENOSHA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.