Basic Information
| Provider Information | |||||||||
| NPI: | 1780766998 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASPIRUS SPECIALISTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1223 | ||||||||
| Address2: | |||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544021223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158472304 | ||||||||
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| Practice Location | |||||||||
| Address1: | 215 N 28TH AVE | ||||||||
| Address2: | |||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544014100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158472866 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | DANNER | ||||||||
| AuthorizedOfficialFirstName: | F | ||||||||
| AuthorizedOfficialMiddleName: | DEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7158472975 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0200X | WI | Y | Ambulatory Health Care Facilities | Clinic/Center | Oncology |
ID Information
| ID | Type | State | Issuer | Description | 21253300 | 05 | WI | MEDICAID | 5465450001 | 01 | WI | DMEPOS | OTHER |