Provider Demographics
NPI:1689976474
Name:ASPIRUS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ASPIRUS MEDICAL GROUP, INC.
Other - Org Name:ASPIRUS PODIATRY ASSOCIATES
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 1:29980 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1299
Mailing Address - Country:US
Mailing Address - Phone:715-847-2304
Mailing Address - Fax:715-843-1188
Practice Address - Street 1:1445 MERRILL AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2646
Practice Address - Country:US
Practice Address - Phone:715-675-3231
Practice Address - Fax:715-675-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1689976474Medicaid
0212750025Medicare NSC
000039315Medicare PIN