Healthcare Provider Details

I. General information

NPI: 1427680057
Provider Name (Legal Business Name): ORTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BIDDLE RD STE 102
MEDFORD OR
97504-6178
US

IV. Provider business mailing address

750 BIDDLE RD STE 102
MEDFORD OR
97504-6178
US

V. Phone/Fax

Practice location:
  • Phone: 541-208-1785
  • Fax: 541-653-8196
Mailing address:
  • Phone: 541-208-1785
  • Fax: 541-653-8196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: DANA JORGENSEN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 541-322-1794