Provider Demographics
NPI:1083955165
Name:ASPIRUS WAUSAU HOSPITAL, INC.
Entity Type:Organization
Organization Name:ASPIRUS WAUSAU HOSPITAL, INC.
Other - Org Name:ASPIRUS OUTPATIENT THERAPIES - PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REVENUE CYCLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-847-2988
Mailing Address - Street 1:520 N 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4101
Mailing Address - Country:US
Mailing Address - Phone:715-843-1058
Mailing Address - Fax:
Practice Address - Street 1:3200 WESTHILL DR STE 100
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4706
Practice Address - Country:US
Practice Address - Phone:715-843-1058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1083955165Medicaid
WI1083955165Medicaid