Provider Demographics
NPI:1295880318
Name:AUBURN ORTHOPAEDIC MEDICAL GROUP
Entity type:Organization
Organization Name:AUBURN ORTHOPAEDIC MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:HENRICHSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-885-0674
Mailing Address - Street 1:11720 EDUCATION ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2419
Mailing Address - Country:US
Mailing Address - Phone:530-885-0674
Mailing Address - Fax:530-885-7179
Practice Address - Street 1:11720 EDUCATION ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2419
Practice Address - Country:US
Practice Address - Phone:530-885-0674
Practice Address - Fax:530-885-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG149110174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG14911OtherSTATE MEDICAL LICENSE
CAAH1364481OtherDEA NUMBER
CAG14911OtherSTATE MEDICAL LICENSE
CAZZZ75723ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER