Healthcare Provider Details

I. General information

NPI: 1457617615
Provider Name (Legal Business Name): ALBANY GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 ELM ST SW SUITE 101
ALBANY OR
97321-2062
US

IV. Provider business mailing address

832 ELM ST SW SUITE 101
ALBANY OR
97321-2062
US

V. Phone/Fax

Practice location:
  • Phone: 541-812-5820
  • Fax: 541-812-5821
Mailing address:
  • Phone: 541-812-5820
  • Fax: 541-812-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DAVID TRIEBES
Title or Position: CEO
Credential:
Phone: 541-812-4102