Provider Demographics
NPI:1073547295
Name:AURORA HEALTH CARE METRO, INC.
Entity Type:Organization
Organization Name:AURORA HEALTH CARE METRO, INC.
Other - Org Name:AURORA PHARMACY #1012
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONAL IMPROVEMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-803-3266
Mailing Address - Street 1:5900 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-3171
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5900 S LAKE DR
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-3171
Practice Address - Country:US
Practice Address - Phone:414-489-4600
Practice Address - Fax:414-489-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7485-423336I0012X
3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5123574OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WI1073547295Medicaid
5123574OtherOTHER ID NUMBER-COMMERCIAL NUMBER