Provider Demographics
NPI:1154468205
Name:ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.
Entity Type:Organization
Organization Name:ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.
Other - Org Name:ASPIRUS THERAPY - PRENTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-748-8159
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 1:619 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:PRENTICE
Practice Address - State:WI
Practice Address - Zip Code:54556-1131
Practice Address - Country:US
Practice Address - Phone:715-428-2626
Practice Address - Fax:715-428-2627
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-30
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40427000Medicaid
WI40427000Medicaid