Healthcare Provider Details

I. General information

NPI: 1518988310
Provider Name (Legal Business Name): SMDC MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E 2ND ST
DULUTH MN
55805-1913
US

IV. Provider business mailing address

502 E 2ND ST
DULUTH MN
55805-1913
US

V. Phone/Fax

Practice location:
  • Phone: 218-727-8762
  • Fax:
Mailing address:
  • Phone: 218-727-8762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number331196
License Number StateMN

VIII. Authorized Official

Name: KEVIN BOREN
Title or Position: CFO
Credential:
Phone: 218-786-1009