1780648659 NPI number — ASPIRUS EAGLE RIVER HOSPITAL & CLINICS, INC

Table of content: (NPI 1780648659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780648659 NPI number — ASPIRUS EAGLE RIVER HOSPITAL & CLINICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPIRUS EAGLE RIVER HOSPITAL & CLINICS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ASPIRUS EAGLE RIVER HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780648659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29980 NETWORK PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60673-1299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-847-2304
Provider Business Mailing Address Fax Number:
715-843-1188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAGLE RIVER
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54521-8835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-479-7411
Provider Business Practice Location Address Fax Number:
715-479-0395
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PECK
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
VP REVENUE CYCLE
Authorized Official Telephone Number:
715-847-2988

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  1000 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11018900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com