Provider Demographics
NPI:1164165569
Name:OPEN DOOR MEDICAL CLINIC
Entity Type:Organization
Organization Name:OPEN DOOR MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:406-781-4414
Mailing Address - Street 1:2 5TH ST N STE 201
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-4011
Mailing Address - Country:US
Mailing Address - Phone:406-781-4414
Mailing Address - Fax:406-205-0700
Practice Address - Street 1:2 5TH ST N STE 201
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-4011
Practice Address - Country:US
Practice Address - Phone:406-781-4414
Practice Address - Fax:406-205-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty