Provider Demographics
NPI:1093879439
Name:ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.
Entity Type:Organization
Organization Name:ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.
Other - Org Name:ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REVENUE CYCLE
Authorized Official - Prefix:
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 1:135 S GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1622
Mailing Address - Country:US
Mailing Address - Phone:715-748-8100
Mailing Address - Fax:715-748-8199
Practice Address - Street 1:135 S GIBSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1622
Practice Address - Country:US
Practice Address - Phone:715-748-8100
Practice Address - Fax:715-748-8199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
WI4917-0423336I0012X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
450770N00OtherAMERICAN HOSPITAL ASSOC
WI33124500Medicaid
5107215OtherNCPDP
450770N00OtherAMERICAN HOSPITAL ASSOC
521324Medicare ID - Type Unspecified