Provider Demographics
NPI:1255664827
Name:AUBURN REGIONAL MEDICAL GROUP
Entity Type:Organization
Organization Name:AUBURN REGIONAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATONAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-447-4770
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98071-0399
Mailing Address - Country:US
Mailing Address - Phone:253-447-4770
Mailing Address - Fax:253-447-4771
Practice Address - Street 1:21220 SR 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8458
Practice Address - Country:US
Practice Address - Phone:253-447-4770
Practice Address - Fax:253-447-4771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7147549Medicaid
WA7147549Medicaid