AGNESIAN HEALTHCARE (NPI# 1770529828) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770529828 |
| Entity Type | Organization |
| Organization Name | AGNESIAN HEALTHCARE |
| Other Organization Name | FOND DU LAC REGIONAL CLINIC |
| Practice Address |
137 Cambria St Randolph WI 53956 |
| Mailing Address |
420 E Division St Fond Du Lac WI 54935-4560 |
| Practice Telephone | 9209265303 |
| Mailing Telephone | 9209268340 |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2007-11-26 |
| Authorized Official Name | STEVEN N LITTLE (SVP & CFO) |
| Authorized Official Telephone | 9209265402 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| Other Name | Type Code |
|---|---|
| FOND DU LAC REGIONAL CLINIC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013157981 | Agnesian Healthcare | Community/Behavioral Health | 1567 E Sumner St, Suite 201, Hartford, WI 53027-2608 | 2009-03-04 |
| 1760419733 | Agnesian Healthcare | Durable Medical Equipment & Medical Supplies | 14 Beaver Dam St, Waupun, WI 53963-1869 | 2006-06-27 |
| 1700817657 | Agnesian Healthcare | Clinic/Center | 200 Front St, Suite 3d, Beaver Dam, WI 53916-1667 | 2006-07-06 |
| 1861438913 | Agnesian Healthcare | Durable Medical Equipment & Medical Supplies | 480 E Division St, Fond Du Lac, WI 54935-3734 | 2006-06-20 |
| 1114963261 | Agnesian Healthcare | Durable Medical Equipment & Medical Supplies | 100 Evergreen Rd, Mount Calvary, WI 53057-9726 | 2006-06-20 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | AGNESIAN HEALTHCARE | 933 Newbury St, Ripon, WI 54971-1730 |
| Street Address |
137 CAMBRIA ST |
| City | RANDOLPH |
| State | WI |
| Zip Code | 53956 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194778324 | Shannon N Sandstrom | Nurse Practitioner | 137 Cambria St, Randolph, WI 53956 | 2006-05-18 |
| 1811039761 | Consultants Laboratory of Wi, LLC | Clinical Medical Laboratory | 137 Cambria St, Randolph, WI 53956 | 2007-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336102169 | Melissa Elaine Lucarelli | Family Medicine | 504 S High Street, Randolph, WI 53956 | 2006-04-11 |
| 1497832257 | Randolph Community Clinic Sc | Family Medicine | 504 S High Street, Randolph, WI 53956 | 2006-11-01 |
| 1962052548 | Tessa Lindner | Physical Therapist | 502 N High St, Randolph, WI 53956-1117 | 2019-09-16 |
| 1245646645 | Rebecca Yelle | Occupational Therapist | 509 Williams St, Randolph, WI 53956-1122 | 2014-07-07 |
| 1003959529 | James Leslie Jones | Chiropractor | 175 Stark St, Randolph, WI 53956-1243 | 2007-02-14 |
| 1801955950 | Ross D Werner | Dentist | 125 N High St, Randolph, WI 53956-1267 | 2006-12-06 |
| 1356383822 | Md Group II LLC | Durable Medical Equipment & Medical Supplies | 107 N High St, Randolph, WI 53956-1267 | 2006-06-11 |
| 1457961971 | Myriel Jamae Werner | Dentist | 125 N High St, Randolph, WI 53956-1267 | 2020-08-10 |
| 1154711190 | Randolph Family Dental LLC | Dentist | 125 N High St, Randolph, WI 53956-1267 | 2015-01-29 |
| 1326333006 | Michelle Dreger | Pharmacist | 107 N High St, Randolph, WI 53956-1267 | 2011-06-10 |
| Find all providers in zip 53956 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164721940 | Homedus Inc | Durable Medical Equipment & Medical Supplies | 1152 Route 10, Unit T, Randolph, NJ 07869-1823 | 2011-03-20 |
| 1750555041 | Starpoint Medical Inc. | Durable Medical Equipment & Medical Supplies | 500 N/ Main St. #b, Randolph, MA 02368-6700 | 2008-04-17 |
| 1225256563 | Lasalle Health Service Inc | Durable Medical Equipment & Medical Supplies | 24 Mazzeo Dr., Randolph, MA 02368-1653 | 2007-04-23 |
| 1134220502 | Pathmark Stores Inc | Durable Medical Equipment & Medical Supplies | Kmart Plaza Us Rt 10, Randolph, NJ 07869 | 2006-09-26 |
| 1376642645 | Maxi Drug Inc | Durable Medical Equipment & Medical Supplies | 47 Memorial Parkway, Randolph, MA 02368-4505 | 2006-09-22 |
| 1477569689 | Maxi Green Inc | Durable Medical Equipment & Medical Supplies | 12 North Main Street, Randolph, VT 05060-1127 | 2006-07-31 |
| 1417962606 | Walgreen Eastern Co Inc | Durable Medical Equipment & Medical Supplies | 170 N Main St, Randolph, MA 02368-4629 | 2006-07-29 |
| 1932124591 | Great Atlantic & Pacific Tea Company Inc | Durable Medical Equipment & Medical Supplies | 148 Center Grove Rd, Randolph, NJ 07869-1325 | 2006-07-13 |
| 1356383822 | Md Group II LLC | Durable Medical Equipment & Medical Supplies | 107 N High St, Randolph, WI 53956-1267 | 2006-06-11 |
| 1407802028 | Acme Markets Inc | Durable Medical Equipment & Medical Supplies | 690 Millbrook Ave, Randolph, NJ 07869 | 2006-05-25 |
| Find all providers in RANDOLPH | ||||
Please comment or provide details below to improve the information on AGNESIAN HEALTHCARE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.