Healthcare Provider Details

I. General information

NPI: 1689722969
Provider Name (Legal Business Name): AURORA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S 10TH AVE
STURGEON BAY WI
54235-1802
US

IV. Provider business mailing address

5200 VIRGINIA WAY 4TH FLOOR L&C DEPT
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 920-746-7955
  • Fax: 920-746-7974
Mailing address:
  • Phone: 615-320-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY BAILET
Title or Position: PRESIDENT
Credential:
Phone: 414-647-6322