Basic Information
Provider Information | |||||||||
NPI: | 1558691832 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ASPIRUS WAUSAU HOSPITAL INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ASPIRUS FAMILY WALK IN | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1008 | ||||||||
Address2: |   | ||||||||
City: | WAUSAU | ||||||||
State: | WI | ||||||||
PostalCode: | 544021008 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7158472304 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2720 PLAZA DR | ||||||||
Address2: | SUITE 1100 | ||||||||
City: | WAUSAU | ||||||||
State: | WI | ||||||||
PostalCode: | 544014158 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7158472472 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/08/2010 | ||||||||
LastUpdateDate: | 01/08/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SCZYGELSKI | ||||||||
AuthorizedOfficialFirstName: | SIDNEY | ||||||||
AuthorizedOfficialMiddleName: | C | ||||||||
AuthorizedOfficialTitleorPosition: | SR VP/CFO | ||||||||
AuthorizedOfficialTelephone: | 7158472250 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | ASPIRUS WAUSAU HOSPITAL INC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/08/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center |   |
ID Information
ID | Type | State | Issuer | Description | 1558691832 | 05 | WI |   | MEDICAID | CC8777 | 01 | WI | RAILROAD | OTHER |