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NPI Code Detail

MEDICARE: AGNESIAN HEALTHCARE

MEDICARE: AGNESIAN HEALTHCARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1861438913
Entity Type Code : Organization
Provider Name (Legal Business Name) : AGNESIAN HEALTHCARE
Provider Business Mailing Address
First Line : 420 E DIVISION ST
Second Line :
City : FOND DU LAC
State : WI
Zip : 54935-4560
Country : US
Telephone Number : 920-926-8340
Fax Number :
Provider Business Practice Location Address
First Line : 480 E DIVISION ST
Second Line :
City : FOND DU LAC
State : WI
Zip : 54935-3734
Country : US
Telephone Number : 920-926-4100
Fax Number :
Authorized Official
Title or Position : SVP & CFO
Name : STEVEN N LITTLE
Credential :
Telephone Number : 920-926-5402
Provider Enumeration Date : 06/20/2006
Last Update Date : 11/26/2007

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Directions to “AGNESIAN HEALTHCARE ” Practice Location

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