Healthcare Provider Details

I. General information

NPI: 1467977025
Provider Name (Legal Business Name): SPOONER HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 CHANDLER DR
SPOONER WI
54801-2202
US

IV. Provider business mailing address

1280 CHANDLER DR
SPOONER WI
54801-2202
US

V. Phone/Fax

Practice location:
  • Phone: 715-635-2111
  • Fax: 715-635-1555
Mailing address:
  • Phone: 715-635-2111
  • Fax: 715-635-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: REBECCA BUSCH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 715-939-1732