Basic Information
| Provider Information | |||||||||
| NPI: | 1821614710 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAYCARE AURORA KAUKAUNA SURGERY CENTER LLC | ||||||||
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| OtherOrganizationName: | KAUKAUNA SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 W FOREST HOME AVE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532152843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146476326 | ||||||||
| FaxNumber: | 4143891509 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 ARBOR WAY | ||||||||
| Address2: | |||||||||
| City: | KAUKAUNA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203727150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2020 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCGINNIS | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 9206365614 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 100152368 | 05 | WI | MEDICAID |