Provider Demographics
NPI:1912182882
Name:AURORA HEALTH CARE CLINIC LLC
Entity Type:Organization
Organization Name:AURORA HEALTH CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:907-696-5680
Mailing Address - Street 1:12320 OLD GLENN HWY
Mailing Address - Street 2:STE A
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7598
Mailing Address - Country:US
Mailing Address - Phone:907-696-5680
Mailing Address - Fax:907-696-5688
Practice Address - Street 1:12320 OLD GLENN HWY
Practice Address - Street 2:STE A
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7598
Practice Address - Country:US
Practice Address - Phone:907-696-5680
Practice Address - Fax:907-696-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK364363LF0000X
AK660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK153313Medicare PIN