THE DULUTH CLINIC LTD NPI 1275839193

NPI Information

NPI: 1275839193
Provider Name: THE DULUTH CLINIC, LTD

Doing Business As: ESSENTIA HEALTH LAKEWALK CLINIC

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
1502 LONDON RD STE 102
DULUTH, MN
ZIP 55812
Phone: (218) 576-0100
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THE DULUTH CLINIC, LTD is a multi-specialty clinic center in Duluth, MN. THE DULUTH CLINIC, LTD NPI is 1275839193. The provider is registered as an organization entity type.
The provider Is Doing Business As Essentia Health Lakewalk Clinic.

The provider's business location address is:

1502 LONDON RD STE 102
DULUTH, MN
ZIP 55812-787
Phone: (218) 576-0100
Fax: (218) 576-0126

The provider's authorized official is Kevin Boren .
The authorized official title is Vp Of Finance and has the following contact phone number (218) 786-1009.

The CLIA number assigned to this NPI record is 24D0404121 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/10/2011 and was last updated on 2/28/2024.

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	261QM1300X	Clinic/Center	Multi-Specialty			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	1275839193	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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