Provider Demographics
NPI:1902869472
Name:ALBANY EMERGENCY PHYSICIANS SERVICES, PC
Entity Type:Organization
Organization Name:ALBANY EMERGENCY PHYSICIANS SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMERGENCY DEPART MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VANASCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-926-2244
Mailing Address - Street 1:PO BOX 2065
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98111-2065
Mailing Address - Country:US
Mailing Address - Phone:888-633-0083
Mailing Address - Fax:
Practice Address - Street 1:1046 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321
Practice Address - Country:US
Practice Address - Phone:503-926-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR168103Medicaid
79195OtherWASHINGTON LABOR & IND
OR070409Medicaid
WA7066368Medicaid
CD7791OtherRAILROAD MEDICARE
CD7791OtherRAILROAD MEDICARE
0000WFBDQMedicare ID - Type Unspecified