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General NPI Number Information
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NPI Number | 1124110325
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Entity Type | Organization
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Legal Business Name | ROSEBURG VA HEALTH CARE SYSTEM
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 913 NW GARDEN VALLEY BLVD
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City | ROSEBURG
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State | OR
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Zip | 97470-6523
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Country | US
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Telephone | 541-957-0653
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Fax |
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Provider Business Mailing Address
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Address Line | 913 NW GARDEN VALLEY BLVD
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City | ROSEBURG
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State | OR
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Zip | 97470-6523
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Country | US
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Telephone | 541-957-0653
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Fax |
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Authorized Official
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Title or Position | CHIEF DENTIST
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Name | DR. ROSELLEN E KIMBROUGH
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Credential | DDS
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Telephone | 541-440-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 7677
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License Number State | OR
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