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Organization
AGNESIAN HEALTHCARE INC
Active
Organization
AGNESIAN HEALTHCARE INC
Active
Other names
SSM HEALTH FOND DU LAC REGIONAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
AMY J GRINNELL (VP-FINANCE, CFO)
(608) 260-3586
Entity
Organization
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 923-7400
Mailing address
1808 W BELTLINE HWY, MADISON, WI 53713-2334
(608) 250-1593
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207L00000X
Anesthesiology Physician
—
—
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
213E00000X
Podiatrist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32841900
—
WI
05
—
38437100
—
WI
01
—
CY0124
RAILROAD MEDICARE GRP #
WI
Enumeration date
11/22/2005
Last updated
06/05/2024
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