Ssm Health Fond Du Lac Regional Clinic

LBN: Agnesian Healthcare Inc
Ssm Health Fond Du Lac Regional Clinic is an health care organization with primary practice located at 420 E Division St , Fond Du Lac WI 54935-4560. The organization recently has 15 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Ophthalmology, Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Otolaryngology, Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Urology, Podiatric Medicine & Surgery Service Providers / Podiatrist, Suppliers / Durable Medical Equipment & Medical Supplies. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty. Agnesian Healthcare Inc can be contacted via phone (920) 923-7400, or through Grinnell, Amy J via phone (608) 260-3586.

Contact Information

Primary practice address
420 E Division St Fond Du Lac WI 54935-4560
Phone: (920) 923-7400
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Grinnell, Amy J
Phone: (608) 260-3586

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X
Allopathic & Osteopathic Physicians / Dermatology 207N00000X
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X
Allopathic & Osteopathic Physicians / Pediatrics 208000000X
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X
Allopathic & Osteopathic Physicians / Surgery 208600000X
Allopathic & Osteopathic Physicians / Urology 208800000X
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X

Profile Details

NPI number 1730162991
LBN Legal business name Agnesian Healthcare Inc
DBA Doing business as Ssm Health Fond Du Lac Regional Clinic
Authorized official Grinnell, Amy J
Entity Organization
Organization subpart 1 No
Enumeration date Nov 22nd, 2005
Last updated Jun 5th, 2024 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730162991 NPPES
Wisconsin MEDICAID 32841900
Wisconsin Other CY0124
Wisconsin MEDICAID 38437100

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