Provider Demographics
NPI:1790482057
Name:JORGENSEN FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:JORGENSEN FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-677-6553
Mailing Address - Street 1:110 PARADISE POINT LN
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8631
Mailing Address - Country:US
Mailing Address - Phone:541-430-7898
Mailing Address - Fax:
Practice Address - Street 1:1813 W HARVARD AVE STE 140
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2743
Practice Address - Country:US
Practice Address - Phone:541-677-6553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty