Provider Demographics
NPI:1679706022
Name:ASPIRUS STEVENS POINT HOSPITAL & CLINICS, INC.
Entity type:Organization
Organization Name:ASPIRUS STEVENS POINT HOSPITAL & CLINICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP & CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-847-2526
Mailing Address - Street 1:29980 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1299
Mailing Address - Country:US
Mailing Address - Phone:715-847-2304
Mailing Address - Fax:
Practice Address - Street 1:209 PRENTICE STREET NORTH
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481
Practice Address - Country:US
Practice Address - Phone:715-345-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPIRUS STEVENS POINT HOSPITAL & CLINICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-02
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1217261Q00000X
WI1217 ST PT261QM0801X
WI1216 STPT324500000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42116400 ST PT OFFCMedicaid
WI42116400 ST PT OFFCMedicaid
WI42143900 WAUPACAMedicaid
WI42116421-DAY TREATMEMedicaid
WI84920 STEVENS POINTMedicare PIN