NPIMap

Organization Active NPI

The Duluth Clinic, LTD.

  • Community/Retail Pharmacy
  • Superior, WI
National Provider Identifier
1477979326
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
9247-42 Issued in 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
Last updated
Feb 29, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 29, 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 9247-42 WI Primary

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 names 1

  • Essentia Health Superior East Pharmacy Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

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

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 5

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

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
The Duluth Clinic LTD2202 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 assignmentParticipating since Oct 24, 2022

National Provider Directory

National Provider Directory
Tax ID family
Duluth Clinic-Ely35 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.

NPI Registry JSON

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

{
    "created_epoch": "1394755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1477979326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 E 2ND ST.",
            "address_2": "SUITE 477",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548805395",
            "telephone_number": "715-817-7999",
            "fax_number": "715-392-0215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 E 2ND ST.",
            "address_2": "SUITE 477",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548805395",
            "telephone_number": "715-817-7999",
            "fax_number": "715-392-0215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DULUTH CLINIC, LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2014-03-14",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "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": "WI",
            "license": "9247-42",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Superior East Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Superior, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.