Wausau Aviation Medicine Services

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

27936 Issued in WI

Legal business name

WAUSAU AVIATION MEDICINE SERVICES

Practice address

915 Woods Place
Wausau, WI 54403-7074

Phone

(715) 675-5371

Fax

(715) 675-5381

NPI assigned

Feb 20, 2007

Last updated

Mar 15, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Glenn Brigham Burt III, M.D.

Title

Owner

Phone

(715) 675-5371

Specialties & licenses 1

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458000000000",
    "number": "1356486369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 477",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544020477",
            "telephone_number": "715-675-5371",
            "fax_number": "715-675-5381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 WOODS PLACE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544037074",
            "telephone_number": "715-675-5371",
            "fax_number": "715-675-5381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUSAU AVIATION MEDICINE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2016-03-15",
        "status": "A",
        "authorized_official_last_name": "BURT",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "BRIGHAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-675-5371",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "27936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21286900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "201533595018",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Wausau Family Pharmacy LLC
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• Family Medicine Physician in Wausau, WI
• Providers in Wausau, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.