# CITY OF KENOSHA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CITY OF KENOSHA
- **Other names:** City of Kenosha Ambulance
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1447308606
- **Legal business name:** CITY OF KENOSHA
- **Authorized official:** MR. JAMES POLTROCK (DIVISION CHIEF OF EMS)
- **Authorized official phone:** (262) 653-4097

## Contact information

- **Practice address:** 4810 60TH ST, KENOSHA, WI 53144-2451
- **Practice address phone:** (262) 653-4097
- **Practice address fax:** (262) 653-4107
- **Mailing address:** 4810 60TH ST, KENOSHA, WI 53144-2451
- **Mailing address phone:** (262) 653-4097
- **Mailing address fax:** (262) 653-4107

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 6000422 | WI | Yes |

## Other

- **Enumeration date:** 01/06/2007
- **Last updated:** 03/17/2018