NPIMap

Organization Active NPI

The Duluth Clinic, LTD

Doing business as Essentia Health Lakewalk Pharmacy

  • Community/Retail Pharmacy
  • Duluth, MN
National Provider Identifier
1003114539
Registry record updated Feb 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
263667 Issued in MN
Legal business name
THE DULUTH CLINIC, LTD
Doing business as
Essentia Health Lakewalk Pharmacy
Practice address
1502 London Rd
Suite 101
Duluth, MN 55812-1788
Phone
(218) 733-1110
Fax
(218) 733-1112
NPI assigned
Mar 8, 2011
Last updated
Feb 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 263667 MN Primary

Addresses

Primary practice location

1502 London Rd
Suite 101
Duluth, MN 55812-1788

Mailing address

1502 London Rd
Suite 101
Duluth, MN 55812-1788
Phone (218) 786-3563

Other identifiers 3

IdentifierTypeStateIssuer
573OtherMNTHE DULUTH CLINIC, LTD. CHAIN CODE
1003114539MedicaidMN
2430712OtherMNNCPDP

Other names 1

  • Essentia Health Lakewalk Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151103001283 MN Part B Supplier - Mass Immunization (Roster Biller Only) 2567374283 16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Virginia, MN; Two Harbors, MN; Silver Bay, MN; International Falls, MN; Hinckley, MN; Hibbing, MN; Hermantown, MN; Grand Rapids, MN…
O20221103002189 MN DME Supplier - Pharmacy 2567374283 Practice locations: Duluth, MN

Other NPIs with the same Medicare PAC ID 24

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 24

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Deer River Community CL35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1502 London Rd
Ste 101
Duluth, MN 55812
Phone (218) 576-0150

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/5836/brand/3/csg/1/fhir/r4

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1299542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709078400000",
    "number": "1003114539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 LONDON RD",
            "address_2": "SUITE 101",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558121788",
            "telephone_number": "218-786-3563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 LONDON RD",
            "address_2": "SUITE 101",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558121788",
            "telephone_number": "218-733-1110",
            "fax_number": "218-733-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DULUTH CLINIC, LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2011-03-08",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "218-786-1009"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "263667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THE DULUTH CLINIC, LTD. CHAIN CODE",
            "identifier": "573",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003114539",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2430712",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Lakewalk Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.