Basic Information
| Provider Information | |||||||||
| NPI: | 1629179908 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASPIRUS WAUSAU HOSPITAL, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ASPIRUS WAUSAU HOSPITAL KIDNEY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1008 | ||||||||
| Address2: | |||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544021008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158472121 | ||||||||
| FaxNumber: | 7158472286 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 WESTHILL DR | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544013795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158472121 | ||||||||
| FaxNumber: | 7158472286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCZYGELSKI | ||||||||
| AuthorizedOfficialFirstName: | SIDNEY | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7158472121 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ASPIRUS WASUAU HOSPITAL, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | 188 | WI | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
ID Information
| ID | Type | State | Issuer | Description | 43180300 | 05 | WI | MEDICAID | 3053 | 01 | WI | SECURITY HEALTH PLAN | OTHER |