Provider Demographics
NPI:1649406448
Name:ASPIRUS DOCTORS CLINIC
Entity type:Organization
Organization Name:ASPIRUS DOCTORS CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 8040
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-8040
Mailing Address - Country:US
Mailing Address - Phone:715-423-0122
Mailing Address - Fax:
Practice Address - Street 1:410 DEWEY ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4715
Practice Address - Country:US
Practice Address - Phone:715-423-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPIRUS DOCTORS CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center