Ssm Health Fond Du Lac Regional Clinic is a
Family Medicine based in Fond Du Lac, Wisconsin. Ssm Health Fond Du Lac Regional Clinic is licensed to practice in * (Not Available) (license number ) and their current practice location is
420 E Division St, Fond Du Lac, Wisconsin. It can be reached at their office (for appointments etc.) via phone at
(920) 923-7400.
NPI number for Ssm Health Fond Du Lac Regional Clinic is 1730162991 and their current mailing address is 1808 W Beltline Hwy, Madison, Wisconsin. Ssm Health Fond Du Lac Regional Clinic
does not participate in medicare program and thus does not accept medicare assignments. The facility's NPI Number is 1730162991.
Healthcare Provider's Profile
| Full Name | Ssm Health Fond Du Lac Regional Clinic |
|---|
| Type | Facility |
|---|
| Speciality | Family Medicine |
|---|
| Location | 420 E Division St, Fond Du Lac, Wisconsin |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1730162991
- Provider Enumeration Date: 11/22/2005
- Last Update Date: 05/24/2023
Medical Identifiers
Medical identifiers for Ssm Health Fond Du Lac Regional Clinic such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1730162991 | NPI | - | NPPES |
| 32841900 | Medicaid | WI | |
| 38437100 | Medicaid | WI | |
| CY0124 | Other | WI | RAILROAD MEDICARE GRP # |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 152W00000X | Optometrist | (* (Not Available)) | Secondary |
| 207L00000X | Anesthesiology | (* (Not Available)) | Secondary |
| 207N00000X | Dermatology | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207V00000X | Obstetrics & Gynecology | (* (Not Available)) | Secondary |
| 207W00000X | Ophthalmology | (* (Not Available)) | Secondary |
| 207X00000X | Orthopaedic Surgery | (* (Not Available)) | Secondary |
| 207Y00000X | Otolaryngology | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Secondary |
| 208600000X | Surgery | (* (Not Available)) | Secondary |
| 208800000X | Urology | (* (Not Available)) | Secondary |
| 213E00000X | Podiatrist | (* (Not Available)) | Secondary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ssm Health Fond Du Lac Regional Clinic is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ssm Health Fond Du Lac Regional Clinic
1808 W Beltline Hwy,
Madison, WI 53713-2334
Ph: (608) 250-1593 | Ssm Health Fond Du Lac Regional Clinic
420 E Division St,
Fond Du Lac, WI 54935-4560
Ph: (920) 923-7400 |
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