1134342082 NPI number — AURORA MEDICAL GROUP, INC.

Table of content: (NPI 1134342082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134342082 NPI number — AURORA MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AURORA MEDICAL GROUP, 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:
1134342082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2307 S BUSINESS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHEBOYGAN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53081-6133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-459-1134
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2307 S BUSINESS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHEBOYGAN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53081-6133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-459-1134
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HANSON
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
LEIGH
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
414-299-1623

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 32833400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32845400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB6422 . This is a "RAILROAD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 32746700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32829300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42230800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32857500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32858600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32877700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32840700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42237400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32845300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 490004223 . This is a "RAILROAD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 32751200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41912800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32751400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32854200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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