Provider Demographics
NPI:1548438765
Name:AURORA WEST 129
Entity type:Organization
Organization Name:AURORA WEST 129
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEKIERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-844-4400
Mailing Address - Street 1:80 S RIVER ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-5178
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 S RIVER ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-5178
Practice Address - Country:US
Practice Address - Phone:630-844-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID=========01Medicaid