Provider Demographics
NPI:1427680057
Name:ORTC, LLC
Entity type:Organization
Organization Name:ORTC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-322-1794
Mailing Address - Street 1:750 BIDDLE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6178
Mailing Address - Country:US
Mailing Address - Phone:541-208-1785
Mailing Address - Fax:541-653-8196
Practice Address - Street 1:750 BIDDLE RD STE 102
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6178
Practice Address - Country:US
Practice Address - Phone:541-208-1785
Practice Address - Fax:541-653-8196
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-11
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone