Basic Information
| Provider Information | |||||||||
| NPI: | 1386677060 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASPIRUS STEVENS POINT SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1165 | ||||||||
| Address2: | |||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544021165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158472148 | ||||||||
| FaxNumber: | 7158472286 | ||||||||
| Practice Location | |||||||||
| Address1: | 5409 VERN HOLMES DR | ||||||||
| Address2: | |||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544818853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153421015 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 03/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | SCZYGELSKI | ||||||||
| AuthorizedOfficialFirstName: | SIDNEY | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7158472250 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | WI | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 41915200 | 05 | WI | MEDICAID | 52D1052765 | 01 | WI | CLIA NUMBER | OTHER |