1649562778 NPI number — AURORA ADVANCED HEALTHCARE, 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 1649562778 NPI number — AURORA ADVANCED HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AURORA ADVANCED HEALTHCARE, 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:
1649562778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3003 W GOOD HOPE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53209-2042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-352-3100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2999 N. MAYFAIR ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WAUWATOSA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-479-7000
Provider Business Practice Location Address Fax Number:
414-479-7001
Provider Enumeration Date:
05/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MONROE
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
414-352-3100

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41570800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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