NPIMap

Organization Active NPI

St. Mary's Duluth Clinic Health System

Doing business as SMDC Clinical Laboratory

  • Clinical Medical Laboratory
  • Duluth, MN
National Provider Identifier
1326078049
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
24D0404052 Issued in NU
Legal business name
ST. MARY'S DULUTH CLINIC HEALTH SYSTEM
Doing business as
SMDC Clinical Laboratory
Practice address
402 E 2ND St
Duluth, MN 55805-1906
Phone
(218) 786-4000
NPI assigned
Jul 5, 2006
Last updated
Aug 23, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. MARY'S DULUTH CLINIC HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 23, 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
Clinical Medical Laboratory 291U00000X 24D0404052 NU Primary

Addresses

Primary practice location

402 E 2ND St
Duluth, MN 55805-1906

Mailing address

402 E 2ND St
Duluth, MN 55805-1906
Phone (218) 786-3167

Other identifiers 1

IdentifierTypeStateIssuer
1326078049MedicaidMN

Other names 1

  • SMDC Clinical Laboratory Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080115000692 MN Part B Supplier - Independent Clinical Laboratory 3678485042 Practice locations: Duluth, MN

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0404052St Mary's/Duluth Clinic Health System/402 E Second Street, Duluth, MN 55805AccreditationJan 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
St Mary's Duluth Clinic Health System2 organizations share this tax ID, including this one
Part of
St Mary's Duluth Clinic Health System

Other organizations with this tax ID 1

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

Member organizations 67

Organizations listed as members of this organization in the National Provider Directory.

View all 67

Ownership & related parties

All facility ownership & control disclosures 25

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Essentia Health - St Josephs Medical CenterBrainerd, MN, CCN 240075 Hospital Operational/Managerial Control Jul 1, 2023
Essentia Health DuluthDuluth, MN, CCN 240019A Hospital Operational/Managerial Control Nov 19, 2007
Essentia Health DuluthDuluth, MN, CCN 24T019A Hospital Operational/Managerial Control Nov 19, 2007
Essentia Health St. Mary's Hospital- SuperiorSuperior, WI, CCN 521329 Hospital Operational/Managerial Control Jan 1, 1997
Essentia Health Deer RiverDeer River, MN, CCN 241360 Hospital Operational/Managerial Control (100%) Sep 1, 2012
Essentia Health SandstoneSandstone, MN, CCN 241309 Hospital Operational/Managerial Control (100%) Sep 1, 1997
Essentia Health St. Mary's Hospital- SuperiorSuperior, WI, CCN 52Z329 Hospital Operational/Managerial Control Jan 1, 1997
Essentia Health St Marys Medical CenterDuluth, MN, CCN 240002 Hospital Operational/Managerial Control Jul 31, 2007
Essentia Health Deer RiverDeer River, MN, CCN 24Z360 Hospital Operational/Managerial Control (100%) Sep 1, 2012
Essentia Health SandstoneSandstone, MN, CCN 24Z309 Hospital Operational/Managerial Control (100%) Sep 1, 1997
Essentia Health Northern PinesAurora, MN, CCN 24Z340 Hospital Operational/Managerial Control Jul 1, 2010
Essentia Health Northern PinesAurora, MN, CCN 241340 Hospital Operational/Managerial Control Jul 1, 2010
Essentia Health VirginiaVirginia, MN, CCN 240084 Hospital Operational/Managerial Control Aug 28, 2012
Essentia Health Moose LakeMoose Lake, MN, CCN 241350 Hospital Operational/Managerial Control Aug 1, 2020
Essentia Health Moose LakeMoose Lake, MN, CCN 24Z350 Hospital Operational/Managerial Control Aug 1, 2020
Essentia Health Northern Pines Care CenterAurora, MN, CCN 245469 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2023
Jan 28, 2025
Essentia Health HomesteadDeer River, MN, CCN 245428 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Sep 1, 2012
May 12, 2025
Essentia Health Virginia Care CenterVirginia, MN, CCN 245458 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Aug 28, 2012
Oct 28, 2025
Essentia Health Moose Lake Home CareMoose Lake, MN, CCN 248051 Home health agency Operational/Managerial Control Jul 1, 2023
Essentia Health St Marys Hospice and Palliative Care ServicesDuluth, MN, CCN 241521 Hospice Operational/Managerial Control Jun 26, 2006
Essentia Health Northern Pines ClinicAurora, MN, CCN 243479 Rural health clinic Operational/Managerial Control Jul 1, 2010
Essentia Health International Falls ClinicInternational Falls, MN, CCN 243481 Rural health clinic Operational/Managerial Control Aug 28, 2012
Essentia Health Ely ClinicEly, MN, CCN 243483 Rural health clinic Operational/Managerial Control Aug 28, 2012
Essentia Health Spooner ClinicSpooner, WI, CCN 528584 Rural health clinic Operational/Managerial Control Jan 1, 1997
Essentia Health Hayward ClinicHayward, WI, CCN 528585 Rural health clinic Operational/Managerial Control Jan 1, 1997

Owned or controlled facilities with NPI records 43

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 43

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1326078049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 E 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051906",
            "telephone_number": "218-786-3167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 E 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051906",
            "telephone_number": "218-786-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S DULUTH CLINIC HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY'S DULUTH CLINIC HEALTH SYSTEM",
        "enumeration_date": "2006-07-05",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "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": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": "24D0404052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326078049",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMDC Clinical Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.