Basic Information
| Provider Information | |||||||||
| NPI: | 1972628006 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AURORA HEALTH CARE SOUTHERN LAKES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AURORA LAKELAND MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | W3985 COUNTY ROAD NN | ||||||||
| Address2: | |||||||||
| City: | ELKHORN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531214337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627412000 | ||||||||
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| Practice Location | |||||||||
| Address1: | W3985 COUNTY ROAD NN | ||||||||
| Address2: | |||||||||
| City: | ELKHORN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627412000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 06/11/2018 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | NAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4142991610 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 41758100 | 05 | WI | MEDICAID | 41223100 | 05 | WI | MEDICAID | 41758800 | 05 | WI | MEDICAID | 41758900 | 05 | WI | MEDICAID | 41227100 | 05 | WI | MEDICAID | 11021600 | 05 | WI | MEDICAID |