Provider Demographics
NPI:1386677060
Name:ASPIRUS STEVENS POINT SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ASPIRUS STEVENS POINT SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCZYGELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-847-2250
Mailing Address - Street 1:PO BOX 1165
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54402-1165
Mailing Address - Country:US
Mailing Address - Phone:715-847-2148
Mailing Address - Fax:715-847-2286
Practice Address - Street 1:5409 VERN HOLMES DR
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-8853
Practice Address - Country:US
Practice Address - Phone:715-342-1015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41915200Medicaid
WI52D1052765OtherCLIA NUMBER
WI52D1052765OtherCLIA NUMBER
WI41915200Medicaid