Provider Demographics
NPI:1720389018
Name:OPEN DOOR MIDWIFERY, LLC
Entity Type:Organization
Organization Name:OPEN DOOR MIDWIFERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DOERR
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:608-634-3664
Mailing Address - Street 1:215 RAMSLAND ST
Mailing Address - Street 2:
Mailing Address - City:WESTBY
Mailing Address - State:WI
Mailing Address - Zip Code:54667-1031
Mailing Address - Country:US
Mailing Address - Phone:608-634-3664
Mailing Address - Fax:608-634-3665
Practice Address - Street 1:215 RAMSLAND ST
Practice Address - Street 2:
Practice Address - City:WESTBY
Practice Address - State:WI
Practice Address - Zip Code:54667-1031
Practice Address - Country:US
Practice Address - Phone:608-634-3664
Practice Address - Fax:608-634-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38255900Medicaid