1609414382 NPI number — AURORA HEALTH SERVICES, LLC

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 1609414382 NPI number — AURORA HEALTH SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AURORA HEALTH SERVICES, LLC
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:
6
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:
1609414382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
993 BRODHEAD RD STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOON TWP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15108-2331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-996-9100
Provider Business Mailing Address Fax Number:
724-784-0452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
645 RODI ROAD
Provider Second Line Business Practice Location Address:
STE 301
Provider Business Practice Location Address City Name:
PENN HILLS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15235-1523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-996-9100
Provider Business Practice Location Address Fax Number:
724-784-0452
Provider Enumeration Date:
12/12/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
RAQUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE OWNER
Authorized Official Telephone Number:
412-996-9100

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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