NPIMap

Organization Active NPI

Agnesian Healthcare

Doing business as Fond Du Lac Regional Clinic

  • Durable Medical Equipment & Medical Supplies
  • Randolph, WI
National Provider Identifier
1770529828
Registry record updated Nov 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
AGNESIAN HEALTHCARE
Doing business as
Fond Du Lac Regional Clinic
Practice address
137 Cambria St
Randolph, WI 53956
Phone
(920) 926-5303
NPI assigned
Jun 20, 2006
Last updated
Nov 26, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2007

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

Authorized official

Name
Steven N 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

137 Cambria St
Randolph, WI 53956

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
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

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": "1196035200000",
    "number": "1770529828",
    "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": "137 CAMBRIA ST",
            "city": "RANDOLPH",
            "state": "WI",
            "postal_code": "53956",
            "telephone_number": "920-926-5303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGNESIAN HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2007-11-26",
        "status": "A",
        "authorized_official_last_name": "LITTLE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "N",
        "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 Randolph, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2007; 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.