1780663989 NPI number — ASPIRUS STANLEY HOSPITAL & CLINICS, INC

Table of content: (NPI 1780663989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780663989 NPI number — ASPIRUS STANLEY HOSPITAL & CLINICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPIRUS STANLEY 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 THORP CLINIC
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:
1780663989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 PINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STANLEY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54768-1297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-644-5530
Provider Business Mailing Address Fax Number:
715-644-6223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 S CLARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THORP
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54771-7624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-669-7279
Provider Business Practice Location Address Fax Number:
715-669-5674
Provider Enumeration Date:
01/16/2006

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: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 43061000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".