Provider Demographics
NPI:1710066584
Name:ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.
Entity Type:Organization
Organization Name:ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.
Other - Org Name:ASPIRUS PRENTICE CLINIC
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 1:1511 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:PRENTICE
Practice Address - State:WI
Practice Address - Zip Code:54556-1155
Practice Address - Country:US
Practice Address - Phone:715-428-2521
Practice Address - Fax:715-428-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21303400Medicaid
WI21303400Medicaid
WI21303400Medicaid
WI21303400Medicaid