Provider Demographics
NPI:1316082746
Name:AUBURN OBGYN PC
Entity type:Organization
Organization Name:AUBURN OBGYN PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEGHORST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-927-0035
Mailing Address - Street 1:1310 E 7TH ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-2518
Mailing Address - Country:US
Mailing Address - Phone:260-927-0035
Mailing Address - Fax:260-927-0036
Practice Address - Street 1:1310 E 7TH ST
Practice Address - Street 2:SUITE M
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2518
Practice Address - Country:US
Practice Address - Phone:260-927-0035
Practice Address - Fax:260-927-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200421440AMedicaid