Provider Demographics
NPI:1700044732
Name:BEN D. ORTEGA , M.D. INC.
Entity Type:Organization
Organization Name:BEN D. ORTEGA , M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:440-886-2300
Mailing Address - Street 1:5500 RIDGE RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2394
Mailing Address - Country:US
Mailing Address - Phone:440-886-2300
Mailing Address - Fax:440-886-1153
Practice Address - Street 1:5500 RIDGE RD
Practice Address - Street 2:SUITE 213
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-2394
Practice Address - Country:US
Practice Address - Phone:440-886-2300
Practice Address - Fax:440-886-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350346510174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9311201Medicare PIN