AGNESIAN HEALTHCARE INC NPI 1730162991

NPI Information

NPI: 1730162991
Provider Name: AGNESIAN HEALTHCARE INC

Doing Business As: SSM HEALTH FOND DU LAC REGIONAL CLINIC

Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
420 E DIVISION ST
FOND DU LAC, WI
ZIP 54935
Phone: (920) 923-7400
Get Directions

AGNESIAN HEALTHCARE INC is a family medicine in Fond Du Lac, WI. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. AGNESIAN HEALTHCARE INC NPI is 1730162991. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Ssm Health Fond Du Lac Regional Clinic.

The provider's business location address is:

420 E DIVISION ST
FOND DU LAC, WI
ZIP 54935-560
Phone: (920) 923-7400

The provider's authorized official is Katherine Vergos .
The authorized official title is President and has the following contact phone number (920) 926-4979.

The enumeration date for this NPI number is 11/22/2005 and was last updated on 5/24/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Primary
1	152W00000X	Optometrist	No
2	207L00000X	Anesthesiology	No
3	207N00000X	Dermatology	No
4	207R00000X	Internal Medicine	No
5	207V00000X	Obstetrics & Gynecology	No
6	207W00000X	Ophthalmology	No
7	207X00000X	Orthopaedic Surgery	No
8	207Y00000X	Otolaryngology	No
9	208000000X	Pediatrics	No
10	208100000X	Physical Medicine & Rehabilitation	No
11	208600000X	Surgery	No
12	208800000X	Urology	No
13	213E00000X	Podiatrist	No
14	332B00000X	Durable Medical Equipment & Medical Supplies	No
15	207Q00000X	Family Medicine	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	32841900	MEDICAID	WISCONSIN
2	38437100	MEDICAID	WISCONSIN
3	CY0124	OTHER	WISCONSIN	RAILROAD MEDICARE GRP #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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