Kenosha Surgicenter LLC
Non-Pharmacy Dispensing Site in Kenosha, WI. Organization (NPI-2).
NPI number1760101992
StatusActive
Last updated in NPPESAug 23, 2022
Details
- NPI
- 1760101992
- Entity type
- Organization (NPI-2)
- Legal business name
- Kenosha Surgicenter LLC
- Organization subpart
- No
- Enumeration date
- Aug 23, 2022
- Certification date
- Aug 23, 2022
- Last updated
- Aug 23, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 332900000X | Non-Pharmacy Dispensing Site | – | – | Yes |
Practice location
10105 74th St Ste 102Kenosha, WI 53142-7530
Phone 262-297-7246 · Fax 888-701-0578
Mailing address
2500 W Layton Ave Ste 120Milwaukee, WI 53221-5400
Phone 262-297-7246
Authorized official
Kevin Eugene Hooker
Hr
2622977246
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