Provider Demographics
NPI:1992737464
Name:ROSEBURG VA HEALTHCARE SYSTEM
Entity type:Organization
Organization Name:ROSEBURG VA HEALTHCARE SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CENTER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-440-1000
Mailing Address - Street 1:913 NW GARDEN VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-6513
Mailing Address - Country:US
Mailing Address - Phone:541-607-7584
Mailing Address - Fax:541-600-7581
Practice Address - Street 1:913 NW GARDEN VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-6513
Practice Address - Country:US
Practice Address - Phone:541-607-7584
Practice Address - Fax:541-600-7581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1177261QM0850X, 261QM1300X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Not Answered282NR1301XHospitalsGeneral Acute Care HospitalRural