Healthcare Provider Details

I. General information

NPI: 1407501059
Provider Name (Legal Business Name): AURORA COMMUNITY CLINIC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2022
Last Update Date: 02/12/2022
Certification Date: 02/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W STATE ST
MEDFORD WI
54451-1772
US

IV. Provider business mailing address

N4895 LANG FARM DR
MEDFORD WI
54451-8889
US

V. Phone/Fax

Practice location:
  • Phone: 157-484-4337
  • Fax: 715-748-6304
Mailing address:
  • Phone: 715-748-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL KLINNER
Title or Position: SECRETARY
Credential: DC
Phone: 715-748-4433