Provider Demographics
NPI:1780037929
Name:AURORA HEALTH CARE VENTURES INC
Entity Type:Organization
Organization Name:AURORA HEALTH CARE VENTURES INC
Other - Org Name:AURORA VISION CENTER- NORTHWEST CLINIC
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 1:7878 N 76TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-3914
Mailing Address - Country:US
Mailing Address - Phone:414-586-5668
Mailing Address - Fax:414-586-5669
Practice Address - Street 1:7878 N 76TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-3914
Practice Address - Country:US
Practice Address - Phone:414-586-5668
Practice Address - Fax:414-586-5669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100061583Medicaid