Provider Demographics
NPI:1417030529
Name:ROSEBURG VA HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:ROSEBURG VA HEALTHCARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1800-549-8387
Mailing Address - Street 1:3631 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-1904
Mailing Address - Country:US
Mailing Address - Phone:541-689-8474
Mailing Address - Fax:
Practice Address - Street 1:2400 RIVER RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2042
Practice Address - Country:US
Practice Address - Phone:541-345-5395
Practice Address - Fax:541-345-7360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA