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General NPI Number Information
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NPI Number | 1326078049
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Entity Type | Organization
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Legal Business Name | ST. MARY'S DULUTH CLINIC HEALTH SYSTEM
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 402 E 2ND ST
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City | DULUTH
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State | MN
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Zip | 55805-1906
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Country | US
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Telephone | 218-786-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 402 E 2ND ST
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City | DULUTH
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State | MN
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Zip | 55805-1906
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Country | US
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Telephone | 218-786-3167
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Fax |
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | KEVIN BOREN
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Credential |
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Telephone | 218-786-1009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 24D0404052
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License Number State |
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