Provider Demographics
NPI:1427278001
Name:AUBURN FAMILY MEDICAL CENTER, INC., P.S.
Entity type:Organization
Organization Name:AUBURN FAMILY MEDICAL CENTER, INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:THURSTON
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:2539-393-6043
Mailing Address - Street 1:202 NO DIVISION ST, PLAZA 2
Mailing Address - Street 2:STE 405
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-4939
Mailing Address - Country:US
Mailing Address - Phone:253-939-3604
Mailing Address - Fax:253-735-4167
Practice Address - Street 1:202 N DIVISION ST # 2
Practice Address - Street 2:STE 405
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-4939
Practice Address - Country:US
Practice Address - Phone:253-939-3604
Practice Address - Fax:253-735-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAU0041OtherREGENCE BLUE SHIELD
CO5099OtherRAILROAD MEDICARE
WA64340OtherDEPT OF L & I
WA7120108Medicaid
WA217128400Medicare ID - Type Unspecified
WAAU0041OtherREGENCE BLUE SHIELD