Basic Information
| Provider Information | |||||||||
| NPI: | 1861448821 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUBURN ANESTHESIA ASSOCIATES, INC. PS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3598 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981243598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253533788 | ||||||||
| FaxNumber: | 4253538041 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 N DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980014939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538337711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 11/21/2007 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDS | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4253533788 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 7016249 | 05 | WA | MEDICAID |