Healthcare Provider Details

I. General information

NPI: 1356699193
Provider Name (Legal Business Name): ALBANY GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HICKORY ST NW STE 200
ALBANY OR
97321-1700
US

IV. Provider business mailing address

400 HICKORY ST NW STE 200
ALBANY OR
97321-1700
US

V. Phone/Fax

Practice location:
  • Phone: 541-812-5800
  • Fax: 541-812-5802
Mailing address:
  • Phone: 541-812-5800
  • Fax: 541-812-5802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

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