Provider Demographics
NPI:1770510240
Name:OPEN DOOR HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:OPEN DOOR HEALTH SERVICES, INC.
Other - Org Name:SOUTHWAY URGENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:R
Authorized Official - Last Name:ESTEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-281-4257
Mailing Address - Street 1:PO BOX 1676
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-1676
Mailing Address - Country:US
Mailing Address - Phone:765-281-4257
Mailing Address - Fax:765-213-2769
Practice Address - Street 1:1651 E 29TH ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-5886
Practice Address - Country:US
Practice Address - Phone:765-286-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200167970FMedicaid
IN466980Medicare PIN
IN151841Medicare Oscar/Certification