Provider Demographics
NPI:1376637496
Name:ASPIRUS WAUSAU HOSPITAL, INC
Entity Type:Organization
Organization Name:ASPIRUS WAUSAU HOSPITAL, INC
Other - Org Name:ASPIRUS WAUSAU HOSPITAL BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCZYGELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-847-2121
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54402-1008
Mailing Address - Country:US
Mailing Address - Phone:715-847-2121
Mailing Address - Fax:715-847-2286
Practice Address - Street 1:333 PINE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4120
Practice Address - Country:US
Practice Address - Phone:715-847-2121
Practice Address - Fax:715-847-2286
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPIRUS WAUSAU HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI188273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11008500Medicaid
WI3053OtherSECURITY HEALTH PLAN
WI39113824BOtherWPS
WI39113824BOtherWPS
WI3053OtherSECURITY HEALTH PLAN
WI11008500Medicaid