Agnesian Healthcare Inc
Organization Active NPI Multi-Specialty Clinic/Center · Fond Du Lac, WI
NPI 1356476543 · NPPES record last updated Apr 20, 2008
Key facts
- NPI
- 1356476543
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- AGNESIAN HEALTHCARE INC
- Practice address
- 912 S Hickory St
Fond Du Lac, WI 54935-5530 - Phone
- (920) 929-7490
- NPI assigned
- Feb 21, 2007
- Organization subpart
- No
Authorized official
- Name
- Stephanie K Krupp
- Title
- Business Director
- Phone
- (920) 907-3907
Other NPIs on the same Medicare enrollment 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031104000263 | WI | Part B Supplier - Clinic/Group Practice | 1658289624 |
Receives reassigned benefits from 630 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
24100 Calabasas Rd
Ste 100
Calabasas, CA 91302
Phone (818) 578-6454
912 S Hickory St
Fond du Lac, WI 54935
Phone (920) 929-7480
703 W State St
Fox Lake, WI 53933
Phone (920) 926-5840
730 N Margaret St
Markesan, WI 53946
Phone (920) 398-2406
360 S Mountin Dr
Mayville, WI 53050
Phone (920) 387-2111
723 Park Ridge Ln
North Fond du Lac, WI 54937
Phone (920) 926-8600
845 Parkside St
Ste 1
Ripon, WI 54971
845 Parkside St
Ripon, WI 54971
Phone (920) 748-3101
680 W Brown St
Waupun, WI 53963
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
912 S Hickory St
Fond Du Lac, WI 54935-5530
Mailing address
912 S Hickory St
Fond Du Lac, WI 54935-5530
Phone (920) 929-7490
Other names
- MERCURY FAMILY MEDICAL CENTER
Other providers in Fond Du Lac, WI
- Agnesian Healthcare Inc
- Agnesian Healthcare Inc
- Agnesian Healthcare Inc
- Agnesian Healthcare Inc
- Agnesian Healthcare Inc
- Agnesian Healthcare Inc
- Agnesian Healthcare Inc
- Agnesian Healthcare Inc
- Agnesian Healthcare Inc
- Agnesian Healthcare Inc
All providers in Fond Du Lac, WI · Multi-Specialty Clinic/Center in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.