{
"Npi": {
"NPI": "1518073923",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "ESSENTIA HEALTH",
"ParentOrgTIN": null,
"OrgName": "THE DULUTH CLINIC, LTD.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "400 E 3RD ST",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "DULUTH",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55805-1951",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "218-786-3137",
"MailingAddressFaxNumber": "218-722-0103",
"FirstLinePracticeLocationAddress": "400 E 3RD ST",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "DULUTH",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55805-1951",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "218-786-3137",
"PracticeLocationAddressFaxNumber": "218-722-0103",
"EnumerationDate": "08/21/2006",
"LastUpdateDate": "02/28/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOREN",
"AuthorizedOfficialFirstName": "KEVIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "VP OF FINANCE",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "218-786-1009",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "261245",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}