Provider Demographics
NPI:1043397177
Name:AURORA MEDICAL CENTER BAY AREA, INC
Entity Type:Organization
Organization Name:AURORA MEDICAL CENTER BAY AREA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:NAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-299-1610
Mailing Address - Street 1:AURORA HEALTH CARE- PAYOR ACTIVATION
Mailing Address - Street 2:3301 W FOREST HOME AVE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-647-6326
Mailing Address - Fax:414-389-1509
Practice Address - Street 1:3003 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4110
Practice Address - Country:US
Practice Address - Phone:715-735-1721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806019500Medicaid
LA1719117Medicaid
MI1711544TYPE40Medicaid
OH2564336Medicaid
MI1711526TYPE30Medicaid
IL=========Medicaid
WI11001400Medicaid
MN70255300Medicaid
MI1711526TYPE30Medicaid
WI0526520002Medicare NSC
MN70255300Medicaid