Healthcare Provider Details

I. General information

NPI: 1780014407
Provider Name (Legal Business Name): ASPIRUS WAUSAU HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 02/08/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 WESTWOOD CENTER BLVD
WAUSAU WI
54401-2892
US

IV. Provider business mailing address

29980 NETWORK PL
CHICAGO IL
60673-1299
US

V. Phone/Fax

Practice location:
  • Phone: 715-847-2472
  • Fax:
Mailing address:
  • Phone: 715-847-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number188
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JERRY M YANG
Title or Position: SVP & CHIEF FINANCIAL OFFICER
Credential:
Phone: 715-847-2526