SSM HEALTH FOND DU LAC REGIONAL CLINIC
NPI 1083676217
Durable Medical Equipment & Medical Supplies in Fond Du Lac, WI

Q: What is the provider's specialty?

The provider's specialty is Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.

Active since April 04, 2006CLIA 52D2197672 · Waiver

421 CAMELOT DR, FOND DU LAC, WI 54935(920) 926-8332 Get Directions Write a Review

NPPES record last updated: June 5, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jun 5, 2024, Jan 24, 2022, May 23, 2019 (3 updates tracked since 2019).

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About Ssm Health Fond Du Lac Regional Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SSM HEALTH FOND DU LAC REGIONAL CLINIC (NPI 1083676217) is a healthcare organization registered as a durable medical equipment & medical supplies in Fond Du Lac, Wisconsin and active in the NPI registry since April 2006. The organization holds a CLIA Waiver certificate valid through October 26, 2026 and lists Amy Grinnell, Vp-finance, Cfo, as its authorized official.

NPPES Registry Identity

NPI1083676217

Entity TypeOrganization

Primary Taxonomy332B00000X

Legal Business NameAGNESIAN HEALTHCARE INC

Location Address421 CAMELOT DRFond Du Lac, WI 54935-8335

Mailing Address1808 W Beltline HwyMadison, WI 53713-2334 · (608) 250-1593

Phone(920) 926-8332

Organization SubpartNo

Authorized OfficialAmy GrinnellVp-finance, Cfo · (608) 260-3586

Enumeration DateApril 4, 2006

Last NPPES UpdateJune 5, 20243 updates tracked since enumeration

NPPES CertifiedJune 5, 2024

✔ NPI 1083676217 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDurable Medical Equipment & Medical SuppliesSuppliers

Taxonomy Code332B00000X

Definition

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.

421 CAMELOT DR, Fond Du Lac, WI 54935

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Other Names 1

Doing Business AsSsm Health Fond Du Lac Regional Clinic

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D2197672

Agnesian Healthcare Adult Day Services · Fond Du Lac, WI

Active · expires Oct 26, 2026

CLIA Number52D2197672

Laboratory TypeAssisted Living Facility

Certificate Effective DateOctober 27, 2024

Certificate Expiration DateOctober 26, 2026

Laboratory DirectorMs. Julie A. Schwartz

Laboratory Phone(920) 926-5099

Laboratory LocationAgnesian Healthcare Adult Day Services420 E Merill Avenue, Fond Du Lac, WI 54935

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KARL PENNAU MD

Orthopaedic Surgery