Healthcare Provider Details

I. General information

NPI: 1154468205
Provider Name (Legal Business Name): ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 BRIDGE ST
PRENTICE WI
54556-1131
US

IV. Provider business mailing address

135 S GIBSON ST
MEDFORD WI
54451-1622
US

V. Phone/Fax

Practice location:
  • Phone: 715-428-2626
  • Fax: 715-428-2627
Mailing address:
  • Phone: 715-748-8100
  • Fax: 715-748-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier40427000
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer

VIII. Authorized Official

Name: GREG SHAW
Title or Position: VP FINANCE
Credential:
Phone: 715-748-8159