Provider Demographics
NPI:1083024509
Name:ALBANY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:ALBANY GENERAL HOSPITAL
Other - Org Name:SAMARITAN WOUND CARE AND HYPERBARIC OXYGEN THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:TRIEBES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:541-812-4102
Mailing Address - Street 1:400 HICKORY ST NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1046 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1916
Practice Address - Country:US
Practice Address - Phone:541-812-4000
Practice Address - Fax:541-812-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty