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General NPI Number Information
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NPI Number | 1497002091
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Entity Type | Organization
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Legal Business Name | VA ROSEBURG HEALTH CARE SYSTEM
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 607 CORONA LOOP RD
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City | ROSEBURG
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State | OR
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Zip | 97471-9133
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Country | US
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Telephone | 541-733-2909
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Fax |
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Provider Business Mailing Address
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Address Line | 607 CORONA LOOP
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City | ROSEBURG
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State | OR
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Zip | 97471
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Country | US
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Telephone | 541-733-2909
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Fax |
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Authorized Official
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Title or Position | RN
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Name | JOSHUA LESTER BRACKEN
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Credential |
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Telephone | 541-733-2909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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