Provider Demographics
NPI:1295001832
Name:ALBANY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:ALBANY GENERAL HOSPITAL
Other - Org Name:SAMARITAN WEST ALBANY FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIEBES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-812-4102
Mailing Address - Street 1:2615 WILLETTA ST SW
Mailing Address - Street 2:SUITE C1
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3404
Mailing Address - Country:US
Mailing Address - Phone:541-812-5793
Mailing Address - Fax:
Practice Address - Street 1:2615 WILLETTA ST SW
Practice Address - Street 2:SUITE C1
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3404
Practice Address - Country:US
Practice Address - Phone:541-812-5793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty