Provider Demographics
NPI:1609265123
Name:ALBANY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:ALBANY GENERAL HOSPITAL
Other - Org Name:SAMARITAN NEUROPSYCHOLOGY ALBANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1:534 PLEASANT VIEW WAY NW, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1700
Mailing Address - Country:US
Mailing Address - Phone:541-812-5760
Mailing Address - Fax:
Practice Address - Street 1:534 PLEASANT VIEW WAY NW, SUITE 200
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1700
Practice Address - Country:US
Practice Address - Phone:541-812-5760
Practice Address - Fax:541-812-5650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14-1459103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500686944Medicaid