Healthcare Provider Details

I. General information

NPI: 1164165569
Provider Name (Legal Business Name): OPEN DOOR MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 5TH ST N STE 204
GREAT FALLS MT
59401-4011
US

IV. Provider business mailing address

2 5TH ST N STE 204
GREAT FALLS MT
59401-4011
US

V. Phone/Fax

Practice location:
  • Phone: 67-508-2804
  • Fax: 406-205-0700
Mailing address:
  • Phone: 406-750-8280
  • Fax: 406-205-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. MELONIE PARMLEY
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 406-750-8280