Provider Demographics
NPI:1821307323
Name:ASPIRUS SPECIALISTS, INC
Entity Type:Organization
Organization Name:ASPIRUS SPECIALISTS, INC
Other - Org Name:ASPIRUS GRAND VIEW CARDIOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:DANNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:715-847-2975
Mailing Address - Street 1:PO BOX 1223
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54402-1223
Mailing Address - Country:US
Mailing Address - Phone:715-847-2304
Mailing Address - Fax:
Practice Address - Street 1:N10565 GRANDVIEW LN
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-9622
Practice Address - Country:US
Practice Address - Phone:906-932-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPIRUS SPECIALISTS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000039310Medicare PIN