Healthcare Provider Details

I. General information

NPI: 1922069194
Provider Name (Legal Business Name): AGNESIAN HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E SHEBOYGAN ST
CAMPBELLSPORT WI
53010-2795
US

IV. Provider business mailing address

1808 W BELTLINE HWY
MADISON WI
53713-2334
US

V. Phone/Fax

Practice location:
  • Phone: 920-533-8361
  • Fax:
Mailing address:
  • Phone: 608-250-1593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: AMY GRINNELL
Title or Position: VP-FINANCE, CFO
Credential:
Phone: 608-260-3586