Provider Demographics
NPI:1326190604
Name:AUBURN UNIVERSITY MEDICAL CLINIC
Entity Type:Organization
Organization Name:AUBURN UNIVERSITY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECT - AUMC
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-844-6106
Mailing Address - Street 1:400 LEM MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36849-0001
Mailing Address - Country:US
Mailing Address - Phone:334-844-4416
Mailing Address - Fax:334-844-6126
Practice Address - Street 1:400 LEM MORRISON DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849-0001
Practice Address - Country:US
Practice Address - Phone:334-844-4416
Practice Address - Fax:334-844-6126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010029OtherBLUE CROSS - BLUE SHIELD