AGNESIAN HEALTHCARE ENTERPRISES LLC (NPI# 1912972613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912972613 |
| Entity Type | Organization |
| Organization Name | AGNESIAN HEALTHCARE ENTERPRISES LLC |
| Other Organization Name | AGNESIAN HEALTH SHOPPE |
| Practice Address |
307 Camelot Dr Fond Du Lac WI 54935-8014 |
| Practice Telephone | 9209265277 |
| Mailing Telephone | 9209265277 |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2016-06-03 |
| Authorized Official Name | BONNIE R SCHMITZ (CFO) |
| Authorized Official Telephone | 9209264480 |
| Is Organization Subpart | Y |
| Parent Organization Name | AGNESIAN HEALTHCARE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332BP3500X |
Durable Medical Equipment & Medical Supplies Specialization: Parenteral & Enteral Nutrition |
Suppliers | ||
| N | 332BX2000X |
Durable Medical Equipment & Medical Supplies Specialization: Oxygen Equipment & Supplies |
Suppliers | ||
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | HIRSP | 41725900 | 01 |
| WI | WI CHRONIC DISEASE PROGRA | 41725900 | 01 |
| WI | 41725900 | 05 |
| Other Name | Type Code |
|---|---|
| Agnesian Health Shoppe | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366417917 | Agnesian Healthcare Enterprises LLC | Pharmacy | 904 W Main St, Waupun, WI 53963-1201 | 2006-02-17 |
| 1326013962 | Agnesian Healthcare Enterprises LLC | Pharmacy | 912 S Hickory St, Fond Du Lac, WI 54935-5530 | 2006-02-17 |
| 1659346286 | Agnesian Healthcare Enterprises LLC | Pharmacy | 730 N Margaret St, Markesan, WI 53946-8688 | 2006-02-17 |
| 1174145031 | Agnesian Healthcare Enterprises LLC | Pharmacy | 904 W Main St, Waupun, WI 53963-1201 | 2020-05-14 |
| 1235519455 | Agnesian Healthcare Enterprises LLC | Pharmacy | 421 Camelot Dr, Fond Du Lac, WI 54935-8335 | 2015-06-03 |
| 1104891746 | Agnesian Healthcare Enterprises LLC | Pharmacy | 145 N Main St, Fond Du Lac, WI 54935-3423 | 2006-02-17 |
| 1962477588 | Agnesian Healthcare Enterprises LLC | Pharmacy | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2006-02-17 |
| 1184699704 | Agnesian Healthcare Enterprises LLC | Durable Medical Equipment & Medical Supplies | 239 Trowbridge Dr, Fond Du Lac, WI 54937-9180 | 2006-02-17 |
| Street Address |
307 CAMELOT DR |
| City | FOND DU LAC |
| State | WI |
| Zip Code | 54935-8014 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609482249 | Keziah Sherri Love | Counselor | W390 Wi-23, Fond Du Lac, WI 54935 | 2020-09-18 |
| 1891341988 | Cynthia Louise Singleton | Nurse Practitioner | 16 E 13th St., Fond Du Lac, WI 54935 | 2019-08-14 |
| 1083183297 | Elena Alexandra Giese | Nurse Practitioner | 430 E. Division St, Fond Du Lac, WI 54935 | 2018-11-16 |
| 1669963740 | Elizabeth Anne Machi | Student in an Organized Health Care Education/Training Program | 885 Western Ave Ste 300, Fond Du Lac, WI 54935 | 2018-05-23 |
| 1184150021 | Jordan Moehn | Specialist/Technologist | 633 Prairie Pkwy, Fond Du Lac, WI 54935 | 2017-05-11 |
| 1467856336 | Chuentao Ho | Specialist/Technologist | 45 South National Ave., Fond Du Lac, WI 54935 | 2014-10-21 |
| 1437587961 | Paula Seeley | Nurse Practitioner | 63 West Pioneer Rd, Fond Du Lac, WI 54935 | 2013-10-18 |
| 1144516030 | Bonnie Kay Mallon | Registered Nurse | 118 E 9th St, Fond Du Lac, WI 54935 | 2011-06-20 |
| 1770885600 | Holly Shepard | Counselor | 23 W Scott St., Fond Du Lac, WI 54935 | 2010-11-29 |
| 1437479110 | Ruth Marie Bohn | Occupational Therapy Assistant | 244 North Macy Street, Fond Du Lac, WI 54935 | 2010-06-04 |
| Find all providers in zip 54935 | ||||
| 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 |
|---|---|---|---|---|
| 1518377720 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1060 E Johnson St, Fond Du Lac, WI 54935-8900 | 2014-04-28 |
| 1548372261 | Fond Du Lac Prescription Center, Ltd | Durable Medical Equipment & Medical Supplies | 52 Sheboygan St, Fond Du Lac, WI 54935-4220 | 2006-08-31 |
| 1649285537 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 192 N Main St, Fond Du Lac, WI 54935-3462 | 2006-07-29 |
| 1710904867 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 377 N Rolling Meadows Dr, Fond Du Lac, WI 54937-9726 | 2006-07-16 |
| 1487990651 | Agnesian Healthcare Inc | Durable Medical Equipment & Medical Supplies | 21 S Marr St, Fond Du Lac, WI 54935-4334 | 2012-12-17 |
| 1972749992 | Agnesian Healthcare Inc | Durable Medical Equipment & Medical Supplies | 912 S Hickory St, Fond Du Lac, WI 54935-5530 | 2008-12-22 |
| 1235359118 | Agnesian Healthcare Inc | Durable Medical Equipment & Medical Supplies | 1088 S Main St, Fond Du Lac, WI 54935 | 2007-04-26 |
| 1306993589 | Aurora Medical Group, Inc. | Durable Medical Equipment & Medical Supplies | 210 Wisconsin American Dr, Fond Du Lac, WI 54935-2999 | 2007-01-03 |
| 1861438913 | Agnesian Healthcare | Durable Medical Equipment & Medical Supplies | 480 E Division St, Fond Du Lac, WI 54935-3734 | 2006-06-20 |
| 1689610735 | Agnesian Healthcare Inc | Durable Medical Equipment & Medical Supplies | 145 N Main St, Fond Du Lac, WI 54935-3423 | 2006-06-20 |
| Find all providers in FOND DU LAC | ||||
| City | FOND DU LAC |
| Zip Code | 54935 |
Please comment or provide details below to improve the information on AGNESIAN HEALTHCARE ENTERPRISES LLC.
| 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.