Healthcare Provider Details

I. General information

NPI: 1598417875
Provider Name (Legal Business Name): ESSENTIA HEALTH SURGERY CENTERS-DULUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MILLER TRUNK HWY STE 101
DULUTH MN
55811-5635
US

IV. Provider business mailing address

1600 MILLER TRUNK HWY STE 101
DULUTH MN
55811-5635
US

V. Phone/Fax

Practice location:
  • Phone: 218-606-9200
  • Fax: 218-606-9201
Mailing address:
  • Phone: 218-606-9200
  • Fax: 218-606-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY BEARD
Title or Position: COO
Credential:
Phone: 218-786-2652