Provider Demographics
NPI:1811080328
Name:ASPIRUS DOCTORS CLINIC
Entity type:Organization
Organization Name:ASPIRUS DOCTORS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
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 1:420 DEWEY STREET
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494
Practice Address - Country:US
Practice Address - Phone:715-423-0122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPIRUS DOCTORS CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2009-07-16
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
WI21293000Medicaid
WI=========001OtherTRICARE HEALTHNET
WI=========024OtherBC/BS
WI=========024OtherBC/BS
WI=========001OtherTRICARE HEALTHNET
WI21293000Medicaid