| Agnesian Healthcare Inc | |
|
40 Camelot Dr Fond Du Lac WI 54935-8049 | |
| (920) 907-8201 | |
| (920) 907-8209 |
| Full Name | Agnesian Healthcare Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 40 Camelot Dr, Fond Du Lac, Wisconsin |
| Authorized Official Name and Position | Joseph R Minerath (SYSTEM DIRECTOR - GOV'T REIMB.) |
| Authorized Official Contact | 6084452411 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Agnesian Healthcare Inc 40 Camelot Dr Fond Du Lac WI 54935-8049 Ph: (920) 907-8201 | Agnesian Healthcare Inc 40 Camelot Dr Fond Du Lac WI 54935-8049 Ph: (920) 907-8201 |
| NPI Number | 1841320884 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 01/21/2025 |
| Certification Date | 01/21/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841320884 | NPI | - | NPPES |
| 391995430017 | Other | WI | BCBS GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 2226 (Wisconsin) | Primary |
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