SUSAN MAVIS GOLTZ MD NPI 1811966500

NPI Information

NPI: 1811966500
Provider Name: SUSAN MAVIS GOLTZ, MD
Classification: Obstetrics & Gynecology - 207V00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
1000 E 1ST ST
STE. LL
DULUTH, MN
ZIP 55805
Phone: (218) 722-5629
Get Directions

Susan Mavis Goltz, MD is an obstetrics gynecology in Duluth, MN. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. Susan Mavis Goltz, MD NPI is 1811966500. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1000 E 1ST ST
STE. LL
DULUTH, MN
ZIP 55805-297
Phone: (218) 722-5629
Fax: (218) 722-5148

The NPI 1811966500 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/15/2006 and was last updated on 12/4/2020.

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	174400000X	Specialist		33349	MINNESOTA	No
2	207V00000X	Obstetrics & Gynecology		33349	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	A005	OTHER		TRICARE
2	111079	OTHER	MINNESOTA	UCARE
3	2F932SW	OTHER	MINNESOTA	BLUE CROSS BLUE SHIELD
4	HP22608	OTHER	MINNESOTA	HEALTH PARTNERS
5	31754000	MEDICAID	WISCONSIN
6	346005	OTHER		PREFERRED ONE
7	2055782400	MEDICAID	MINNESOTA
8	0725685	OTHER		MEDICA

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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