1801156054 NPI number — ALBANY GENERAL HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801156054 NPI number — ALBANY GENERAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBANY GENERAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801156054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1086 7TH AVE SW
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97321-1997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-812-3330
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1086 7TH AVE SW
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97321-1997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-812-3330
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TRIEBES
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
541-812-4102

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500651949 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: R0000ZGBCT . This is a "MEDICARE PART B" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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