Provider Demographics
NPI:1487843181
Name:AURORA MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:AURORA MEDICAL GROUP, INC.
Other - Org Name:AURORA HEALTH CENTER SHAWANO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-647-3047
Mailing Address - Street 1:1346 E GREEN BAY ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-2210
Mailing Address - Country:US
Mailing Address - Phone:715-526-6244
Mailing Address - Fax:
Practice Address - Street 1:1346 E GREEN BAY ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2210
Practice Address - Country:US
Practice Address - Phone:715-526-6244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0377550099Medicare NSC