Healthcare Provider Details

I. General information

NPI: 1841359478
Provider Name (Legal Business Name): ST. MARYS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 12/19/2007
Certification Date:
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: 218-786-2392
  • Fax:
Mailing address:
  • Phone: 218-786-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State

VIII. Authorized Official

Name: SUSAN MCCLERNON
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 218-786-4878