Provider Demographics
NPI:1619901832
Name:AURORA HEALTH CARE METRO, INC.
Entity Type:Organization
Organization Name:AURORA HEALTH CARE METRO, INC.
Other - Org Name:ASMC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
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:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53082-0208
Mailing Address - Country:US
Mailing Address - Phone:920-803-3263
Mailing Address - Fax:920-459-2634
Practice Address - Street 1:1020 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1308
Practice Address - Country:US
Practice Address - Phone:414-219-7963
Practice Address - Fax:414-219-7964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI89003336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5123334OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WI1619901832Medicaid
5123334OtherOTHER ID NUMBER-COMMERCIAL NUMBER