Healthcare Provider Details

I. General information

NPI: 1750931945
Provider Name (Legal Business Name): ORTEGO HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 S UNION ST
OPELOUSAS LA
70570-5740
US

IV. Provider business mailing address

2949 S UNION ST
OPELOUSAS LA
70570-5740
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-9606
  • Fax: 337-948-7003
Mailing address:
  • Phone: 337-948-9606
  • Fax: 337-948-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIM ORTEGO
Title or Position: OWNER
Credential:
Phone: 337-948-9606