Provider Demographics
NPI:1104129600
Name:AURORA CENTRE, INC
Entity type:Organization
Organization Name:AURORA CENTRE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-241-1503
Mailing Address - Street 1:1851 N GEMINI DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1607
Mailing Address - Country:US
Mailing Address - Phone:928-266-0118
Mailing Address - Fax:
Practice Address - Street 1:1851 N GEMINI DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1607
Practice Address - Country:US
Practice Address - Phone:928-266-0118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR42907208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty