Basic Information
| Provider Information | |||||||||
| NPI: | 1740422153 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AURORA ADVANCED HEALTHCARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3003 W GOOD HOPE RD | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532092042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143523100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 945 N 12TH ST | ||||||||
| Address2: | SUITE 1200 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532331305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142913300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2009 | ||||||||
| LastUpdateDate: | 07/08/2009 | ||||||||
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| AuthorizedOfficialLastName: | MONROE | ||||||||
| AuthorizedOfficialFirstName: | EUGENE | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4143523100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 41570800 | 05 | WI | MEDICAID |