NPIMap

Organization Active NPI

Agnesian Healthcare

  • Durable Medical Equipment & Medical Supplies
  • Mount Calvary, WI
National Provider Identifier
1114963261
Registry record updated Mar 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
AGNESIAN HEALTHCARE
Practice address
100 Evergreen Rd
Mount Calvary, WI 53057-9726
Phone
(920) 753-2311
NPI assigned
Jun 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Steven Little
Title
SVP & Cfo
Phone
(920) 926-5402

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

100 Evergreen Rd
Mount Calvary, WI 53057-9726

Mailing address

420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-8340

Other names 1

  • FOND DU LAC REGIONAL CLINIC Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300147200000",
    "number": "1114963261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354560",
            "telephone_number": "920-926-8340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 EVERGREEN RD",
            "city": "MOUNT CALVARY",
            "state": "WI",
            "postal_code": "530579726",
            "telephone_number": "920-753-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGNESIAN HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2011-03-15",
        "status": "A",
        "authorized_official_last_name": "LITTLE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "SVP & CFO",
        "authorized_official_telephone_number": "920-926-5402"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOND DU LAC REGIONAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Calvary, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.