Provider Demographics
NPI:1346265550
Name:ALBANY AREA PRIMARY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:ALBANY AREA PRIMARY HEALTH CARE, INC.
Other - Org Name:EAST ALBANY PEDIATRIC & ADOLESCENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-888-6559
Mailing Address - Street 1:PO BOX 50098
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31703-0098
Mailing Address - Country:US
Mailing Address - Phone:229-639-3103
Mailing Address - Fax:229-888-8935
Practice Address - Street 1:1712-C EAST BROAD AVENUE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705
Practice Address - Country:US
Practice Address - Phone:229-639-3103
Practice Address - Fax:229-888-8935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA267797696AMedicaid
GA11-1885Medicare ID - Type UnspecifiedFQHC
GAGRP 1502Medicare ID - Type UnspecifiedGROUP NUMBER