Basic Information
| Provider Information | |||||||||
| NPI: | 1508132150 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALBANY GENERAL HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ALBANY OB/GYN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 ELM ST SW | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ALBANY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973211956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418124850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 705 ELM ST SW | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ALBANY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973211956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418124850 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2012 | ||||||||
| LastUpdateDate: | 03/28/2012 | ||||||||
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| AuthorizedOfficialLastName: | TRIEBES | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5418124102 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.