Basic Information
| Provider Information | |||||||||
| NPI: | 1316165574 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAYCARE AURORA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2845 GREENBRIER RD. | ||||||||
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| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202888000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2845 GREENBRIER RD. | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202888000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | EWALD | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 9202883037 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.