Provider Demographics
NPI:1942412739
Name:VETERANS ADMINISTRATION HOSPITAL
Entity type:Organization
Organization Name:VETERANS ADMINISTRATION HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:503-220-8262
Mailing Address - Street 1:212 SW MEADE ST
Mailing Address - Street 2:APARTMENT #8
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201
Mailing Address - Country:US
Mailing Address - Phone:503-224-0385
Mailing Address - Fax:
Practice Address - Street 1:3710 SW US VETERANS ROAD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97207
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory