OPEN DOOR HEALTH CENTER NPI 1699211862

NPI Information

NPI: 1699211862
Provider Name: OPEN DOOR HEALTH CENTER
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 24D0887412

Address:
1212 E COLLEGE DR
MARSHALL, MN
ZIP 56258
Phone: (507) 532-3607
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OPEN DOOR HEALTH CENTER is a family nurse practitioner in Marshall, MN. OPEN DOOR HEALTH CENTER NPI is 1699211862. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1212 E COLLEGE DR
MARSHALL, MN
ZIP 56258-010
Phone: (507) 532-3607

The provider's authorized official is Douglas L. Jaeger .
The authorized official title is Ceo and has the following contact phone number (507) 344-5500.

The CLIA number assigned to this NPI record is 24D0887412 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/12/2017 and was last updated on 1/12/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	261QF0400X	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	241857	MEDICARE OSCAR/CERTIFICATION	MINNESOTA
2	201094100	MEDICAID	MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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