Provider Demographics
NPI:1922186097
Name:ASPIRUS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ASPIRUS MEDICAL GROUP, INC.
Other - Org Name:ASPIRUS CLINICS, INC
Other - Org Type:Former Legal Business Name
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 1:3000 WESTHILL DR
Practice Address - Street 2:SUITE 108
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3795
Practice Address - Country:US
Practice Address - Phone:715-847-0032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPIRUS MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-02
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RN0300X
WI261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21301600Medicaid
WI=========383OtherBC/BS