KENOSHA RADIOLOGY CENTER LLC. (NPI# 1770540130) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1770540130 |
Entity Type | Organization |
Organization Name | KENOSHA RADIOLOGY CENTER LLC. |
Practice Address |
10117 74th St Suite 150 Kenosha WI 53142-7533 |
Practice Telephone | 2626977770 |
Practice Fax Number | 2626977771 |
Mailing Telephone | 2626977770 |
Mailing Fax Number | 2626977771 |
Enumeration Date | 2006-04-28 |
Last Update Date | 2020-08-22 |
Authorized Official Name | DR. JOHN S. PALLIN (PRESIDENT) |
Authorized Official Telephone | 2626977770 |
Authorized Official Credential | M.D. |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QR0200X |
Clinic/Center Specialization: Radiology |
XM310472 | WI | Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
WI | 21255800 | 05 |
Entity Type | Entity Name | Entity Address |
---|---|---|
System for Award Management (SAM) Entities | KENOSHA RADIOLOGY CENTER LLC | 10117 74th St Ste 150, Kenosha, WI 53142-7533 |
Street Address |
10117 74TH ST SUITE 150 |
City | KENOSHA |
State | WI |
Zip Code | 53142-7533 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1770853574 | Theresa N Otu | Counselor | 10117 74th St, Suite 100, Kenosha, WI 53142-7533 | 2012-01-10 |
1336353572 | Susan Mueller | Counselor | 10117 74th St, Suite 100, Kenosha, WI 53142-7533 | 2007-05-09 |
1780707232 | Stacey Wright | Marriage & Family Therapist | 10117 74th St, Suite 100, Kenosha, WI 53142-7533 | 2007-04-09 |
1770640617 | Jane Cary Pallin | Specialist | 10117 74th St, Suite 150, Kenosha, WI 53142-7533 | 2007-01-02 |
1790842631 | John S Pallin | Specialist | 10117 74th St, Suite 150, Kenosha, WI 53142-7533 | 2007-01-02 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1588297816 | Caring Hearts Home Health Care | In Home Supportive Care | 6021-57th Ave, Suite C103, Kenosha, WI 53142 | 2020-02-14 |
1144785395 | Michael L Wrzesinski | Counselor | 4109 67th Street, Kenosha, WI 53142 | 2019-02-01 |
1720538499 | David Smith | Counselor | 10900 67th Street, Kenosha, WI 53142 | 2016-10-06 |
1326404641 | Smile Doctors Ltd | Dentist | 7003 39th Ave, Kenosha, WI 53142 | 2016-01-04 |
1225409485 | Antonia Marie Decker | Physician Assistant | 10400 75th St. Ste 204, Kenosha, WI 53142 | 2015-10-14 |
1780060582 | Joshua Haas | Pharmacist | 7701 Green Bay Road, Kenosha, IL 53142 | 2015-08-04 |
1811379225 | Dana Mary Stout | Registered Nurse | 7401 104th Avenue, Suite 110, Comprehensive Orthopaedics, S.c., Kenosha, WI 53142 | 2015-06-22 |
1669815569 | Joshua Knute Elson | Radiology | 6811 118th Ave, Kenosha, WI 53142 | 2013-04-10 |
1356610166 | Michael J Gallo | Pharmacist | 7535 North Greenbay Rd, Kenosha, WI 53142 | 2011-12-22 |
1720357999 | Orest Carnevale | Registered Nurse | 7316 155th Ct, Kenosha, WI 53142 | 2011-12-18 |
Find all providers in zip 53142 |
Taxonomy Code | 261QR0200X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Radiology |
Definition to come... |
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---|---|---|---|---|
1649607623 | Touhy Diagnostic At Home LLC | Clinic/Center | 723 58th St, 304, Kenosha, WI 53140-4160 | 2013-10-04 |
1215112966 | Mh Imaging-kenosha LLC | Clinic/Center | 1020 35th Street, Suite 120, Kenosha, WI 53140-1932 | 2007-12-31 |
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1528013992 | Open Mri of Delafield, LLC | Clinic/Center | 3960 Hillside Dr, Suite 106, Delafield, WI 53018-2148 | 2006-05-24 |
1184675506 | Cardiac Evaluation Services Inc | Clinic/Center | 2063 South 116th Street, Milwaukee, WI 53227 | 2006-05-12 |
1295784726 | Mcmc Radiology Services, LLC | Clinic/Center | 5310 W Capitol Dr, Milwaukee, WI 53216-2239 | 2006-05-10 |
1073592473 | Advanced Imaging S.c. | Clinic/Center | 228 S 18th Ave, Sturgeon Bay, WI 54235-1000 | 2006-01-13 |
1669865705 | Oakleaf Clinics Sc | Clinic/Center | 3802 Oakwood Mall Dr, Eau Claire, WI 54701-3016 | 2015-03-13 |
1467710772 | Affiliated Medical Imaging | Clinic/Center | 5310 W Capitol Dr, Suite 108, Milwaukee, WI 53216-2263 | 2012-04-25 |
1598056335 | Germantown Medical Imaging, LLC | Clinic/Center | W178n9912 Rivercrest Dr, Suite 102-a, Germantown, WI 53022-4645 | 2011-04-27 |
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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.