The Duluth Clinic, LTD
Organization Active NPI Anesthesiology Physician · Superior, WI
NPI 1285664995 · NPPES record last updated Feb 28, 2024
Key facts
- NPI
- 1285664995
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anesthesiology Physician 207L00000X
- Legal business name
- THE DULUTH CLINIC, LTD
- Practice address
- 3500 Tower Ave
Superior, WI 54880-5335 - Phone
- (715) 395-5454
- NPI assigned
- Jul 5, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- ESSENTIA HEALTH
Authorized official
- Name
- Kevin Boren
- Title
- VP of Finance
- Phone
- (218) 786-1009
Other NPIs on the same Medicare enrollment 6
Practitioners 49
-
Joseph M Autio, APRN,CRNA
-
Randy A. Braaten, M.D.
-
Anna M Brabec, CRNA
-
Matthew Mark Brabec, RN, CRNA
-
Mark Douglas Burns, APRN, CRNA
-
David Allen Burton, RN, CRNA
-
Gunnar M Christopher, CRNA
-
Richard Cochrane, MD
-
Scott A Eskuri, MD
-
Kenneth J Farrell, M.D.
-
Michelle M Flanagan-Haag, CRNA
-
Mark L. Grim, M.D.
-
Rebecca L Grumdahl, APRN, CRNA
-
Erin Heather Grund, M.D.
-
Dane McGee Ingebrigtson, M.D.
-
Brian David Klocke, CRNA
-
Kelle Marie Klocke, RN, CRNA
-
Levi Garrett La Porte, APRN/CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031103000120 | WI | Part B Supplier - Clinic/Group Practice | 2567374283 |
Receives reassigned benefits from 185 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ashland, WI; Hayward, WI; Mellen, WI; Mequon, WI; Superior, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician |
207L00000X | Yes | ||
| Certified Registered Nurse Anesthetist |
367500000X |
Addresses
Primary practice location
3500 Tower Ave
Superior, WI 54880-5335
Mailing address
3500 Tower Ave
Superior, WI 54880-5335
Phone (715) 395-5454
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285664995 | Medicaid | WI |
Other names
- Superior Clinic
Other providers in Superior, WI
- Olga Mikhaylovna Ter-Grigoryan
- Rodneyt Tester
- The Creative Counseling Group
- The Duluth Clinic, LTD
- The Duluth Clinic, LTD
- The Duluth Clinic, LTD
- The Duluth Clinic, LTD
- The Duluth Clinic, LTD.
- The Duluth Clinic, LTD.
- The Duluth Clinic, LTD.
All providers in Superior, WI · Anesthesiology Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.