Provider Demographics
NPI:1902459209
Name:THE DULUTH CLINIC LTD
Entity Type:Organization
Organization Name:THE DULUTH CLINIC LTD
Other - Org Name:ESSENTIA HEALTH ORTHOPEDIC URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-786-1009
Mailing Address - Street 1:1301 MILLER TRUNK HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-5639
Mailing Address - Country:US
Mailing Address - Phone:218-576-0680
Mailing Address - Fax:218-576-0690
Practice Address - Street 1:1301 MILLER TRUNK HWY STE 400
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-5639
Practice Address - Country:US
Practice Address - Phone:218-576-0680
Practice Address - Fax:218-576-0690
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MARY'S DULUTH CLINIC HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care