PREMISE HEALTH OF WISCONSIN MEDICAL SC
NPI 1760109052
Clinic/Center - Multi-Specialty in Kenosha, WI
NPI Status: Active since October 26, 2022
Contact Information
4303 39TH AVE
KENOSHA, WI
ZIP 53144
Phone: (262) 653-4444
- Organization
- Clinic/Center
- Multi-Specialty
- CLIA Number: 52D2276107
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 02-01-2027
About PREMISE HEALTH OF WISCONSIN MEDICAL SC
This page provides the complete NPI Profile along with additional information for Premise Health Of Wisconsin Medical Sc, a provider established in Kenosha, Wisconsin operating as a Clinic/center, focusing in multi-specialty . The healthcare provider is registered in the NPI registry with number 1760109052 assigned on October 2022. The practitioner's primary taxonomy code is 261QM1300X. The provider is registered as an organization and their NPI record was last updated February 2026. The authorized official of this NPI record is Edward William Schwartz (President)
- NPI
- 1760109052
- Provider Name
- PREMISE HEALTH OF WISCONSIN MEDICAL SC
- Entity Type
- Organization
- Location Address
- 4303 39TH AVE KENOSHA, WI 53144
- Location Phone
- (262) 653-4444
- Mailing Address
- 5500 MARYLAND WAY STE 120 BRENTWOOD, TN 37027
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 10-26-2022
- Last Update Date
- 02-17-2026
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Multi-Specialty
- Taxonomy Code
- 261QM1300X
- Type
- Ambulatory Health Care Facilities
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 52D2276107
- Facility Type
- Physician Office
- Certificate Effective Date
- February 02, 2025
- Certificate Expiration Date
- February 01, 2027
- Laboratory Director
- LISA ARMSTRONG
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Premise Health Of Wisconsin Medical Sc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1760109052, we treat the final digit (2) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 48. The final step is to find the difference between that total and the next multiple of ten (50 - 48 = 2).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 48 is 50. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1760109052, enumerated as an "organization" on October 26, 2022.
The provider is located at 4303 39TH AVE KENOSHA, WI 53144 and the phone number is (262) 653-4444.
Clinic/Center with taxonomy code 261QM1300X and a focus in Multi-Specialty.
