1427278001 NPI number — AUBURN FAMILY MEDICAL CENTER, INC., P.S.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427278001 NPI number — AUBURN FAMILY MEDICAL CENTER, INC., P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUBURN FAMILY MEDICAL CENTER, INC., P.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427278001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 NO DIVISION ST, PLAZA 2
Provider Second Line Business Mailing Address:
STE 405
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98001-4939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-939-3604
Provider Business Mailing Address Fax Number:
253-735-4167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 N DIVISION ST # 2
Provider Second Line Business Practice Location Address:
STE 405
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98001-4939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-939-3604
Provider Business Practice Location Address Fax Number:
253-735-4167
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THURSTON
Authorized Official First Name:
PEGGY
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
25393936043

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AU0041 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CO5099 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64340 . This is a "DEPT OF L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7120108 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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