# ADVANCED VASCULAR THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356726418
- **Authorized official:** GLEN S ROSEBOROUGH M.D. (DIRECTOR)
- **Authorized official phone:** (503) 371-1756

## Contact information

- **Practice address:** 2480 LIBERTY ST NE, SUITE 110, SALEM, OR 97301-8380
- **Practice address phone:** (503) 371-1756
- **Mailing address:** 2480 LIBERTY ST NE, SUITE 110, SALEM, OR 97301-8380
- **Mailing address phone:** (503) 371-1756

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | MD150190 | OR | Yes |

## Other

- **Enumeration date:** 07/29/2015
- **Last updated:** 11/20/2015