Healthcare Provider Details

I. General information

NPI: 1154697001
Provider Name (Legal Business Name): ALBANY GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 NW CIRCLE BLVD SUITE 201
CORVALLIS OR
97330-1967
US

IV. Provider business mailing address

990 NW CIRCLE BLVD SUITE 201
CORVALLIS OR
97330-1967
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-6412
  • Fax: 541-768-6643
Mailing address:
  • Phone: 541-768-6412
  • Fax: 541-768-6643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID TRIEBES
Title or Position: CEO
Credential:
Phone: 541-768-5009