Provider Demographics
NPI:1689977415
Name:ROBLEY REX VETERANS AFFAIRS MEDICAL CENTER (VAMC)
Entity Type:Organization
Organization Name:ROBLEY REX VETERANS AFFAIRS MEDICAL CENTER (VAMC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:502-558-2005
Mailing Address - Street 1:2853 REGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1329
Mailing Address - Country:US
Mailing Address - Phone:502-558-2005
Mailing Address - Fax:
Practice Address - Street 1:2853 REGAN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1329
Practice Address - Country:US
Practice Address - Phone:502-558-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1087566282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access