FOND DU LAC SURGERY CENTER, LLC
NPI 1104874247
Clinic/Center - Ambulatory Surgical in Fond Du Lac, WI
About Fond Du Lac Surgery Center, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FOND DU LAC SURGERY CENTER, LLC (NPI 1104874247) is a healthcare organization registered as an ambulatory surgical in Fond Du Lac, Wisconsin and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through May 7, 2028 and lists Steven N Little, Svp & Cfo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
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 52D1053848
Fond Du Lac Surgery Center A Department Of St Agnes Hospital · Fond Du Lac, WIOther Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Fond Du Lac Surgery Center, LLC's NPI number?
The NPI number for Fond Du Lac Surgery Center, LLC is 1104874247. It was assigned to this organization in the NPPES registry on May 4, 2006.
Where is Fond Du Lac Surgery Center, LLC located?
Fond Du Lac Surgery Center, LLC is located at 421 Camelot Drive, Fond Du Lac, WI 54935. The listed phone number is (920) 926-5407.
What is Fond Du Lac Surgery Center, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.
Does Fond Du Lac Surgery Center, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 52D1053848) is associated with this NPI, valid through May 7, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Fond Du Lac Surgery Center, LLC was last updated on August 29, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Fond Du Lac Surgery Center, Llc · NPI 1104874247
Ambulatory Surgical organization in Fond Du Lac, Wisconsin. Organization record, active in the CMS NPPES registry since May 4, 2006.
## Identity
- **NPI:** 1104874247 (Entity type: Organization)
- **Enumerated:** May 4, 2006
- **Primary specialty:** Clinic/Center - Ambulatory Surgical · taxonomy 261QA1903X
- **Organization subpart:** No
- **Authorized official:** Steven Little, SVP & CFO
## Practice location
- **Address:** 421 CAMELOT DRIVE, Fond Du Lac, WI 54935
- **Phone:** (920) 926-5407
## Record status
- **NPPES last updated:** August 29, 2007
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1104874247) · Data from the CMS NPPES public registry.