Basic Information
| Provider Information | |||||||||
| NPI: | 1740341585 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASPIRUS WAUSAU HOSPITAL, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ASPIRUS WAUSAU HOSPITAL, INC-WEMSA | ||||||||
| 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: | 333 PINE RIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544014120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158472121 | ||||||||
| FaxNumber: | 7158472286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 10/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | SCZYGELSKI | ||||||||
| AuthorizedOfficialFirstName: | SIDNEY | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CHEIF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7158472121 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 188 | WI | N | Hospitals | General Acute Care Hospital | 207P00000X | 188 | WI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 32746900 | 05 | WI | MEDICAID | CT0928 | 01 | WI | RAILROAD MEDICARE | OTHER |