NPIMap

The Duluth Clinic, LTD.

Organization Active NPI Community/Retail Pharmacy · Superior, WI

NPI 1477979326 · NPPES record last updated Feb 29, 2024

Key facts

NPI
1477979326
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
9247-42 (WI)
Legal business name
THE DULUTH CLINIC, LTD.
Practice address
2202 E 2ND St.
Suite 477
Superior, WI 54880-5395
Phone
(715) 817-7999
Fax
(715) 392-0215
NPI assigned
Mar 14, 2014
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 5

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

Other NPIs with the same Medicare PAC ID 24

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

Corporate family (same 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.

Practitioners 1,134

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 1,134

Laboratory certificates & supplier records

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
The Duluth Clinic LTD
2202 E 2ND St, Superior, WI 54880-3779 · (715) 817-7999		 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignment
Participating since Oct 24, 2022

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in WI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20151230000109 WI Part B Supplier - Mass Immunization (Roster Biller Only) 2567374283 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hayward, WI; Superior, WI
O20221010000276 WI DME Supplier - Pharmacy 2567374283 Practice locations: Superior, WI

National Provider Directory

Tax ID family
Duluth Clinic LTD Wi (35 organizations share this tax ID)

Locations

2202 E 2nd St
Ste 477
Superior, WI 54880
Phone (715) 817-7999

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 9247-42 WI Yes

Addresses

Primary practice location

2202 E 2ND St.
Suite 477
Superior, WI 54880-5395

Mailing address

2202 E 2ND St.
Suite 477
Superior, WI 54880-5395
Phone (715) 817-7999

Other identifiers

IdentifierTypeStateIssuer
1477979326OtherNPI
100037008MedicaidWI
1477979326MedicaidMN

Other names

  • Essentia Health Superior East Pharmacy Other name

Other providers in Superior, WI

All providers in Superior, WI · Community/Retail Pharmacy in Wisconsin

Sources for this page

Verify at the official NPI Registry.