Healthcare Provider Details

I. General information

NPI: 1225089634
Provider Name (Legal Business Name): ST. MARY'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E 4TH ST
DULUTH MN
55805-2282
US

IV. Provider business mailing address

407 E 4TH ST
DULUTH MN
55805-2282
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-4020
  • Fax: 218-786-4223
Mailing address:
  • Phone: 218-786-4020
  • Fax: 218-786-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number02562
License Number StateMN

VIII. Authorized Official

Name: KEVIN BOREN
Title or Position: VP OF FINANCE
Credential:
Phone: 218-786-1009