Provider Demographics
NPI:1902563638
Name:THE DULUTH CLINIC LTD
Entity Type:Organization
Organization Name:THE DULUTH CLINIC LTD
Other - Org Name:ESSENTIA HEALTH CLOQUET CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF 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 1:1413 HIGHWAY 33 S
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-2626
Mailing Address - Country:US
Mailing Address - Phone:218-337-4000
Mailing Address - Fax:218-337-4001
Practice Address - Street 1:1413 HIGHWAY 33 S
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-2626
Practice Address - Country:US
Practice Address - Phone:218-337-4000
Practice Address - Fax:218-337-4001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-17
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty