Provider Demographics
NPI:1043245798
Name:SPOONER HEALTH SYSTEM, INC.
Entity type:Organization
Organization Name:SPOONER HEALTH SYSTEM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-939-1732
Mailing Address - Street 1:1280 CHANDLER DR
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-2202
Mailing Address - Country:US
Mailing Address - Phone:715-939-1738
Mailing Address - Fax:715-635-8567
Practice Address - Street 1:801 OAK ST
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-1228
Practice Address - Country:US
Practice Address - Phone:715-939-1738
Practice Address - Fax:715-635-8567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI208251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41525300Medicaid
WI41525300Medicaid
WI=========OtherTAX ID NUMBER