Provider Demographics
NPI:1528435542
Name:MEDICAL DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:MEDICAL DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GULICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-407-7990
Mailing Address - Street 1:111 SUNNYVIEW LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3164
Mailing Address - Country:US
Mailing Address - Phone:406-752-3597
Mailing Address - Fax:406-756-7605
Practice Address - Street 1:111 SUNNYVIEW LANE, STE B
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5709
Practice Address - Country:US
Practice Address - Phone:406-407-7990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty