Basic Information
| Provider Information | |||||||||
| NPI: | 1679706022 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASPIRUS STEVENS POINT HOSPITAL & CLINICS, INC. | ||||||||
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| OtherOrganizationName: | ASPIRUS BEHAVIORAL HEALTH CLINIC - STEVENS POINT - PRENTICE ST | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29980 NETWORK PL | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606731299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158472304 | ||||||||
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| Practice Location | |||||||||
| Address1: | 209 PRENTICE STREET NORTH | ||||||||
| Address2: | |||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153455300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2009 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | PECK | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 7158472988 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ASPIRUS STEVENS POINT HOSPITAL & CLINICS, INC. | ||||||||
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| NPICertificationDate: | 04/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 1217 ST PT | WI | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 324500000X | 1216 STPT | WI | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 261Q00000X | 1217 | WI | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 42116400 ST PT OFFC | 05 | WI | MEDICAID |