Lake Superior Medical Equipment Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

5762874 Issued in MN

Legal business name

LAKE SUPERIOR MEDICAL EQUIPMENT INC

Practice address

4730 Mike Colalillo Dr
Duluth, MN 55807-2723

Phone

(218) 727-0600

Fax

(218) 727-2209

NPI assigned

Jun 13, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Tina Meng

Title

Business Manager

Phone

(218) 727-0600

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Lake Superior Medical Equipment Inc

  • Durable Medical Equipment & Medical Supplies
  • Cloquet, MN
  • NPI 1881038875

  1850504010

  Same PAC ID

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

Tax ID family

Lake Superior Medical Equipment Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Lake Superior Medical Equipment Inc

  • Durable Medical Equipment & Medical Supplies
  • Cloquet, MN
  • NPI 1881038875
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Lake Superior Medical Equipment Inc

  • Durable Medical Equipment & Medical Supplies
  • Cloquet, MN
  • NPI 1881038875
  NPPES parent name

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781654400000",
    "number": "1497759864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4730 MIKE COLALILLO DR",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558072723",
            "telephone_number": "218-727-0600",
            "fax_number": "218-727-2209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 MIKE COLALILLO DR",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558072723",
            "telephone_number": "218-727-0600",
            "fax_number": "218-727-2209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SUPERIOR MEDICAL EQUIPMENT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A",
        "authorized_official_last_name": "MENG",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "218-727-0600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MN",
            "license": "5762874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125158900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "169334",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA/SELECT CARE",
            "identifier": "8200355",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41725700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "275S9LA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lake Superior Community Health Center
• Lake Superior Concierge, Inc.
• Lake Superior Counseling Center
• Lake Superior Dental Associates
• Lake Superior Internal Medicine
• Lake Superior Physical Therapy Inc
• Lake Vision PLLC
• Ronald Lake, MSW LICSW
• Lakeside Dental Associates, PA
• Lakewalk Imaging, LLC

• Durable Medical Equipment & Medical Supplies in Duluth, MN
• Providers in Duluth, MN by specialty
• Durable Medical Equipment & Medical Supplies in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2026; 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.