Provider Demographics
NPI:1821115023
Name:ASPIRUS WAUSAU HOSPITAL, INC
Entity Type:Organization
Organization Name:ASPIRUS WAUSAU HOSPITAL, INC
Other - Org Name:ASPIRUS REFERENCE LABORATORY
Other - Org Type:Doing Business As
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:715-847-2121
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:
Practice Address - Street 1:1900 WESTWOOD DR UNIT 2
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7842
Practice Address - Country:US
Practice Address - Phone:715-847-2229
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:2007-03-23
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI188291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32946900Medicaid
WI520030Medicare ID - Type Unspecified