1043397177 NPI number — AURORA MEDICAL CENTER BAY AREA, INC

Table of content: (NPI 1043397177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043397177 NPI number — AURORA MEDICAL CENTER BAY AREA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AURORA MEDICAL CENTER BAY AREA, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043397177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AURORA HEALTH CARE- PAYOR ACTIVATION
Provider Second Line Business Mailing Address:
3301 W FOREST HOME AVE
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53215-2843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-647-6326
Provider Business Mailing Address Fax Number:
414-389-1509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3003 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARINETTE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54143-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-735-1721
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
NAN
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP FINANCE
Authorized Official Telephone Number:
414-299-1610

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 806019500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1719117 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1711544TYPE40 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2564336 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1711526TYPE30 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: ========= , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11001400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 70255300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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