Southport Healthcare LLC
NPI 1740906874 · Community Health Clinic/Center · Kenosha, WI
Enrolled with Medicare as Part B Supplier - Mass Immunization (roster Biller Only) · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Southport Healthcare LLC is a Community Health Clinic/Center organization in Kenosha, WI (NPI 1740906874).
Provider details
- NPI number
- 1740906874
- Entity type
- Organization
- Primary specialty
- Community Health Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Amber Tueller, Secretary(208) 207-2726
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Kenosha Visiting Nurse Association
Registry dates
- Enumerated
- 2022-10-19
- Last updated
- 2025-06-06
- Certified
- 2025-06-06
Frequently asked questions
- What is Southport Healthcare LLC's NPI number?
- Southport Healthcare LLC's National Provider Identifier (NPI) is 1740906874, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Southport Healthcare LLC?
- Southport Healthcare LLC is classified in the NPPES registry as Community Health Clinic/Center (Ambulatory Health Care Facilities).
- Where is Southport Healthcare LLC located?
- Southport Healthcare LLC's practice location on file with NPPES is 600 52nd St Ste 300, Kenosha, WI 53140-3423.
- What is Southport Healthcare LLC's phone number?
- The practice phone number listed in the NPPES registry for Southport Healthcare LLC is (262) 656-8400.
- Does Southport Healthcare LLC accept Medicare?
- Southport Healthcare LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Southport Healthcare LLC?
- The authorized official listed on Southport Healthcare LLC's NPPES record is Amber Tueller, Secretary. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Southport Healthcare LLC's NPI active?
- Yes — Southport Healthcare LLC's NPI (1740906874) is active in the NPPES registry as of the last update on 2025-06-06.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.