Provider Demographics
NPI:1467151852
Name:AUBURN MEMORIAL MEDICAL SERVICES, PC
Entity Type:Organization
Organization Name:AUBURN MEMORIAL MEDICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY-RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-253-1838
Mailing Address - Street 1:17 LANSING ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-255-7576
Mailing Address - Fax:
Practice Address - Street 1:77 NELSON ST STE 210
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1941
Practice Address - Country:US
Practice Address - Phone:315-567-0797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUBURN MEMORIAL MEDICAL SERVICES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty