1477534246 NPI number — AUBURN IMAGING PARTNERS LLC

Table of content: (NPI 1477534246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477534246 NPI number — AUBURN IMAGING PARTNERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUBURN IMAGING PARTNERS LLC
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:
6
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:
1477534246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FEDERAL WAY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98093-2490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-661-1700
Provider Business Mailing Address Fax Number:
253-661-4565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 3RD ST NE
Provider Second Line Business Practice Location Address:
#300
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98002-4035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-886-5307
Provider Business Practice Location Address Fax Number:
253-886-5323
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LUND
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-661-1700

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7127343 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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