Provider Demographics
NPI:1851478952
Name:ASPIRUS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ASPIRUS MEDICAL GROUP, INC.
Other - Org Name:ASPIRUS LAND O LAKES CLINIC
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 1:4348 HIGHWAY B
Practice Address - Street 2:UNIT B
Practice Address - City:LAND O LAKES
Practice Address - State:WI
Practice Address - Zip Code:54540
Practice Address - Country:US
Practice Address - Phone:715-547-6118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPIRUS MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2020-11-16
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
WI21264600Medicaid
WI=========038OtherTRICARE HEALTHNET
WI21264600Medicaid
WI000064050Medicare Oscar/Certification
WI0212750018Medicare NSC