Healthcare Provider Details

I. General information

NPI: 1013933936
Provider Name (Legal Business Name): ST. MARY'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E 3RD ST
DULUTH MN
55805-1950
US

IV. Provider business mailing address

407 E 3RD ST
DULUTH MN
55805-1950
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-4000
  • Fax:
Mailing address:
  • Phone: 218-786-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number331095
License Number StateMN

VIII. Authorized Official

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