CMS FOND DU LAC
NPI 1265143945
Clinic/Center - Methadone in Fond Du Lac, WI

Q: What is Premier Care Of Wisconsin, LLC.'s NPI number?

The NPI number for Premier Care Of Wisconsin, LLC. is 1265143945. It was assigned to this organization in the NPPES registry on December 13, 2022. The provider is doing business as Cms Fond Du Lac.

Q: What is Premier Care Of Wisconsin, LLC.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Methadone, with taxonomy code 261QM2800X.

Active since December 13, 2022CLIA 52D2100462 · Waiver

23 W SCOTT ST, FOND DU LAC, WI 54935(920) 926-0101(920) 926-0060 Get Directions Write a Review

NPPES record last updated: February 10, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 10, 2024, Dec 13, 2022 (2 updates tracked since 2022).

On this page

About Cms Fond Du Lac NPPES

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

CMS FOND DU LAC (NPI 1265143945) is a healthcare organization registered as a methadone in Fond Du Lac, Wisconsin and active in the NPI registry since December 2022. The organization holds a CLIA Waiver certificate valid through August 13, 2027 and lists Cindy Gaither, Vice President Revenue Cycle Manage, as its authorized official.

NPPES Registry Identity

NPI1265143945

Entity TypeOrganization

Primary Taxonomy261QM2800X

Legal Business NamePREMIER CARE OF WISCONSIN, LLC.

Location Address23 W SCOTT STFond Du Lac, WI 54935-2342

Mailing Address8444 N 90th St Ste 100Scottsdale, AZ 85258-4437 · (160) 248-8886

Phone(920) 926-0101

Fax(920) 926-0060

Organization SubpartNo

Authorized OfficialCindy GaitherVice President Revenue Cycle Manage · (602) 248-8886

Enumeration DateDecember 13, 2022

Last NPPES UpdateFebruary 10, 20242 updates tracked since enumeration

NPPES CertifiedFebruary 10, 2024

✔ NPI 1265143945 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyClinic/Center · MethadoneAmbulatory Health Care Facilities

Taxonomy Code261QM2800X

Definition

An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X

Also ListedCommunity/Behavioral HealthTaxonomy 251S00000X

Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X

Also ListedClinic/Center · Rehabilitation, Substance Use DisorderTaxonomy 261QR0405X

23 W SCOTT ST, Fond Du Lac, WI 54935

Open in Google Maps ↗

Other Names 1

Doing Business AsCms Fond Du Lac

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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 52D2100462

Premier Care Of Wisconsin, LLC Dba Community Medical Services - Fond Du Lac · Fond Du Lac, WI

Active · expires Aug 13, 2027

CLIA Number52D2100462

Laboratory TypeNarcotic Treatment Provid

Certificate Effective DateAugust 14, 2025

Certificate Expiration DateAugust 13, 2027

Laboratory DirectorMr. Justin Abeyta

Laboratory Phone(920) 926-0101

Laboratory LocationPremier Care Of Wisconsin, LLC Dba Community Medical Services - Fond Du Lac23 West Scott St, Fond Du Lac, WI 54935

CLIA data matches this NPI record on: Address Name Phone

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

Leave this field empty

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.

DANIELLE LISNEY

Registered Nurse (Addiction (Substance Use Disorder))