Provider Demographics
| NPI: | 1265629133 |
|---|---|
| Name: | AURORA ADVANCED HEALTHCARE, INC. |
| Entity type: | Organization |
| Organization Name: | AURORA ADVANCED HEALTHCARE, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | NAN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | NELSON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 414-299-1610 |
| Mailing Address - Street 1: | PO BOX 735044 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CHICAGO |
| Mailing Address - State: | IL |
| Mailing Address - Zip Code: | 60673-5044 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 3003 W GOOD HOPE RD |
| Practice Address - Street 2: | |
| Practice Address - City: | MILWAUKEE |
| Practice Address - State: | WI |
| Practice Address - Zip Code: | 53209 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 414-352-3100 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-09-25 |
| Last Update Date: | 2023-09-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| WI | 207K00000X, 207N00000X, 207R00000X, 207V00000X, 207W00000X, 207X00000X, 207Y00000X, 208000000X, 208600000X, 208800000X, 332B00000X, 207Q00000X | |
| 261QM1300X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| WI | 21319500 | Medicaid | |
| WI | 41570800 | Other | MEDICAID - MEDICAL SUPPLY / VENDOR |
| WI | 0626600023 | Medicare NSC | |
| WI | 0626600041 | Medicare NSC | |
| WI | 0626600008 | Medicare NSC | |
| WI | 0626600003 | Medicare NSC | |
| WI | 0626600028 | Medicare NSC | |
| WI | 0626600030 | Medicare NSC | |
| WI | 0626600040 | Medicare NSC | |
| WI | 0626600005 | Medicare NSC | |
| WI | 0626600038 | Medicare NSC | |
| WI | 0626600042 | Medicare NSC | |
| WI | 0626600015 | Medicare NSC | |
| WI | 0626600037 | Medicare NSC | |
| WI | 21319500 | Medicaid | |
| WI | 0626600011 | Medicare NSC | |
| WI | 0626600025 | Medicare NSC | |
| WI | 46236 | Medicare PIN | |
| WI | 01994 | Medicare PIN | |
| WI | 0626600013 | Medicare NSC | |
| WI | 0626600039 | Medicare NSC | |
| WI | 0626600041 | Medicare NSC | |
| WI | 0626600027 | Medicare NSC | |
| WI | 0626600011 | Medicare NSC | |
| WI | 0626600012 | Medicare NSC | |
| WI | 0626600013 | Medicare NSC | |
| WI | 0626600021 | Medicare NSC | |
| WI | 01994 | Medicare PIN | |
| WI | 0626600031 | Medicare NSC | |
| WI | 0626600008 | Medicare NSC | |
| WI | 0626600018 | Medicare NSC | |
| WI | 0626600029 | Medicare NSC | |
| WI | 0626600038 | Medicare NSC | |
| WI | 0626600004 | Medicare NSC | |
| WI | 0626600007 | Medicare NSC | |
| WI | 0626600010 | Medicare NSC | |
| WI | 0626600027 | Medicare NSC |
