LAKE SUPERIOR COMMUNITY HEALTH CENTER NPI 1013556638

NPI Information

NPI: 1013556638
Provider Name: LAKE SUPERIOR COMMUNITY HEALTH CENTER
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
4602 GRAND AVE STE 1000
DULUTH, MN
ZIP 55807
Phone: (218) 336-3520
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LAKE SUPERIOR COMMUNITY HEALTH CENTER is a federally qualified health center (fqhc) clinic center in Duluth, MN. LAKE SUPERIOR COMMUNITY HEALTH CENTER NPI is 1013556638. The provider is registered as an organization entity type.

The provider's business location address is:

4602 GRAND AVE STE 1000
DULUTH, MN
ZIP 55807-712
Phone: (218) 336-3520
Fax: (218) 624-6097

The provider's authorized official is Lee Homan .
The authorized official title is Ceo and has the following contact phone number (715) 392-1955.

The enumeration date for this NPI number is 12/30/2019 and was last updated on 2/13/2024.

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	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

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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