Basic Information
| Provider Information | |||||||||
| NPI: | 1205851870 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUBURN RADIOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1316 E SEVENTH ST | ||||||||
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| City: | AUBURN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467060543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2609254600 | ||||||||
| FaxNumber: | 2609257648 | ||||||||
| Practice Location | |||||||||
| Address1: | 1316 E SEVENTH ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467060543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2609254600 | ||||||||
| FaxNumber: | 2609257648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TRAVIS | ||||||||
| AuthorizedOfficialFirstName: | MITCHELL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2609254600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.