Provider Demographics
NPI:1205851870
Name:AUBURN RADIOLOGY PC
Entity Type:Organization
Organization Name:AUBURN RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-925-4600
Mailing Address - Street 1:1316 E SEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-0543
Mailing Address - Country:US
Mailing Address - Phone:260-925-4600
Mailing Address - Fax:260-925-7648
Practice Address - Street 1:1316 E SEVENTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-0543
Practice Address - Country:US
Practice Address - Phone:260-925-4600
Practice Address - Fax:260-925-7648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN192010Medicare ID - Type Unspecified