Basic Information
Provider Information
NPI: 1699444968
EntityType: 2
ReplacementNPI:  
OrganizationName: ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS & CLINICS, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ASPIRUS WOODRUFF CLINIC - MAPLE STREET
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 29980 NETWORK PL
Address2:  
City: CHICAGO
State: IL
PostalCode: 606731299
CountryCode: US
TelephoneNumber: 7158472304
FaxNumber: 7158472125
Practice Location
Address1: 240 MAPLE ST
Address2:  
City: WOODRUFF
State: WI
PostalCode: 545689190
CountryCode: US
TelephoneNumber: 7153568140
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/09/2021
LastUpdateDate: 03/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: PECK
AuthorizedOfficialFirstName: LORI
AuthorizedOfficialMiddleName: PAIGE
AuthorizedOfficialTitleorPosition: VP OF REVENUE CYCLE
AuthorizedOfficialTelephone: 7157482988
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/29/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261Q00000X  N Ambulatory Health Care FacilitiesClinic/Center 
261QR1300X  Y Ambulatory Health Care FacilitiesClinic/CenterRural Health

No ID Information.


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