1114296480 NPI number — AURORA HEALTH CARE VENTURES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114296480 NPI number — AURORA HEALTH CARE VENTURES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AURORA HEALTH CARE VENTURES 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:
AURORA VISION CENTER- ELM GROVE
Provider Other Organization Name Type Code:
3
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:
1114296480
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W231N1440 CORPORATE CT STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUKESHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53186-1303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-896-6000
Provider Business Mailing Address Fax Number:
262-896-3926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
W231N1440 CORPORATE CT STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUKESHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53186-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-896-6000
Provider Business Practice Location Address Fax Number:
262-896-3926
Provider Enumeration Date:
12/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PANTEL
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATION IMPROVEMENT SPECIALIST
Authorized Official Telephone Number:
920-803-3266

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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