Basic Information
| Provider Information | |||||||||
| NPI: | 1689751711 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AURORA MEDICAL CENTER BAY AREA, INC | ||||||||
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| OtherOrganizationName: | AURORA MEDICAL CENTER BAY AREA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3003 UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | MARINETTE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541434110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7157354200 | ||||||||
| FaxNumber: | 7157351791 | ||||||||
| Practice Location | |||||||||
| Address1: | 3003 UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | MARINETTE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541434110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7157356621 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 10/07/2019 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | NAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SVP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4142991610 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 41665100 | 05 | WI | MEDICAID | 871696152 | 05 | MI | MEDICAID |