THE DULUTH CLINIC LTD NPI 1275839193

NPI Information

  • NPI: 1275839193
  • Provider Name: THE DULUTH CLINIC, LTD
  • Classification: Clinic/Center - 261QM1300X
  • Specialization: Multi-Specialty
  • Entity Type: Organization
  • Doing Business As: ESSENTIA HEALTH LAKEWALK CLINIC
  • CLIA Number: 24D0404121
  • Address: 1502 LONDON RD STE 102
    DULUTH, MN
    ZIP 55812
  • Phone: (218) 576-0100

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NPI Details

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
1261QM1300XClinic/CenterMulti-SpecialtyYes

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
11275839193MEDICAIDMINNESOTA

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: 3/30/2025

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