Healthcare Provider Details

I. General information

NPI: 1710933379
Provider Name (Legal Business Name): COUNTY OF JACKSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SOUTH HOLLY STREET
MEDFORD OR
97501
US

IV. Provider business mailing address

140 SOUTH HOLLY STREET
MEDFORD OR
97501
US

V. Phone/Fax

Practice location:
  • Phone: 541-774-8200
  • Fax: 541-774-7964
Mailing address:
  • Phone: 541-774-8200
  • Fax: 541-774-7964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number200250069NP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK JERRY ORNDOFF
Title or Position: DIRECTOR
Credential: MS SOCIAL SCIENCE
Phone: 541-774-8200