MEDICARE: AUBURN UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1376836163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUBURN UNIVERSITY

Provider Business Mailing Address
First Line	:	101 SOUTH UNION STREET
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36104
Country	:	US
Telephone Number	:	334-844-8670
Fax Number	:	334-844-8256

Provider Business Practice Location Address
First Line	:	101 S UNION ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36130-3022
Country	:	US
Telephone Number	:	334-263-8470
Fax Number	:	334-263-8670

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	GREGORY PEDEN
Credential	:
Telephone Number	:	334-844-4099

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	11/27/2023

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