Provider Demographics
NPI:1912972613
Name:AGNESIAN HEALTHCARE ENTERPRISES LLC
Entity Type:Organization
Organization Name:AGNESIAN HEALTHCARE ENTERPRISES LLC
Other - Org Name:AGNESIAN HEALTH SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-926-4480
Mailing Address - Street 1:307 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-8014
Mailing Address - Country:US
Mailing Address - Phone:920-926-5277
Mailing Address - Fax:
Practice Address - Street 1:307 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-8014
Practice Address - Country:US
Practice Address - Phone:920-926-5277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGNESIAN HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-17
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41725900OtherHIRSP
WI41725900OtherWI CHRONIC DISEASE PROGRA
WI41725900Medicaid
WI=========033OtherBLUE CROSS OF WI
WI4368240003Medicare NSC