Provider Demographics
NPI:1518982628
Name:SPOONER HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:SPOONER HEALTH SYSTEM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-939-1732
Mailing Address - Street 1:1280 CHANDLER DR
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-2202
Mailing Address - Country:US
Mailing Address - Phone:715-635-2111
Mailing Address - Fax:715-939-1555
Practice Address - Street 1:1280 CHANDLER DR
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-2202
Practice Address - Country:US
Practice Address - Phone:715-635-2111
Practice Address - Fax:715-939-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11010010Medicaid
WI3901326OtherMEDICA
WI526491042258OtherPREFERRED ONE
WI11010000Medicaid
MN1404HSPOtherBLUE CROSS MN UB
WI32760900Medicaid
MN300422OtherUCARE OF MN UB
WI197OtherGROUP HEALTH MEDICAL ASST
WI33132300Medicaid
MN400078OtherUCARE OF MN PRO
WI5025337OtherSELECT CARE
MN05305SPOtherBLUE CROSS OF MN PRO
MN836247500OtherMINNESOTA MA
WI526491042258OtherPREFERRED ONE
WI32760900Medicaid
WI11010010Medicaid
WI11010000Medicaid