NPIMap

Organization Active NPI

Agnesian Healthcare Inc

Doing business as Fond Du Lac Regional Clinc

  • Occupational Medicine Physician
  • Fond Du Lac, WI
National Provider Identifier
1154947737
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine PhysicianTaxonomy code 2083X0100X
Legal business name
AGNESIAN HEALTHCARE INC
Doing business as
Fond Du Lac Regional Clinc
Practice address
250 Camelot Dr
Fond Du Lac, WI 54935-8029
Phone
(920) 923-7400
NPI assigned
Jun 19, 2020
Last updated
Jun 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Authorized official

Name
Amy Grinnell
Title
VP-Finance, Cfo
Phone
(608) 260-3586

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2083X0100X Primary

Addresses

Primary practice location

250 Camelot Dr
Fond Du Lac, WI 54935-8029

Mailing address

250 Camelot Dr
Fond Du Lac, WI 54935-8029

Other names 1

  • FOND DU LAC REGIONAL CLINC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fond Du Lac Regional CL27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Locations

250 Camelot Dr
Fond du Lac, WI 54935
Phone (920) 923-7400

NPI Registry JSON

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

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1154947737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 CAMELOT DR",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549358029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CAMELOT DR",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549358029",
            "telephone_number": "920-923-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGNESIAN HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-19",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "GRINNELL",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "VP-FINANCE, CFO",
        "authorized_official_telephone_number": "608-260-3586"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOND DU LAC REGIONAL CLINC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FOND DU LAC REGIONAL CLINC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fond Du Lac, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; 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.