NPIMap

Organization Active NPI

The Duluth Clinic, LTD.

  • Non-Pharmacy Dispensing Site
  • Duluth, MN
National Provider Identifier
1508293259
Registry record updated Sep 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
THE DULUTH CLINIC, LTD.
Practice address
1502 London Rd
Suite 102
Duluth, MN 55812-1788
Phone
(218) 576-0120
Fax
(218) 733-1112
NPI assigned
Sep 26, 2013
Organization subpart
Yes
Parent organization
ST. MARY'S DULUTH CLINIC HEALTH SYSTEMSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 26, 2013

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

Authorized official

Name
Sandra H Mastaw, MT BA
Title
Coordinator Pharmacy Operations
Phone
(218) 786-4265

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

1502 London Rd
Suite 102
Duluth, MN 55812-1788

Mailing address

1502 London Rd
Suite 102
Duluth, MN 55812-1788
Phone (218) 576-0120

Other names 1

  • Essentia Health Medication Therapy Management Services Other name

National Provider Directory

National Provider Directory
Tax ID family
Duluth Clinic LTD Wi35 organizations share this tax ID, including this one
Part of
St Marys Duluth Clinic Health System

Other organizations with this tax ID 34

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

View all 34

Locations

1502 London Rd
Ste 102
Duluth, MN 55812
Phone (218) 576-0100

NPI Registry JSON

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

{
    "created_epoch": "1380153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380153600000",
    "number": "1508293259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 LONDON RD",
            "address_2": "SUITE 102",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558121788",
            "telephone_number": "218-576-0120",
            "fax_number": "218-733-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 LONDON RD",
            "address_2": "SUITE 102",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558121788",
            "telephone_number": "218-576-0120",
            "fax_number": "218-733-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DULUTH CLINIC, LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY'S DULUTH CLINIC HEALTH SYSTEMS",
        "enumeration_date": "2013-09-26",
        "last_updated": "2013-09-26",
        "status": "A",
        "authorized_official_last_name": "MASTAW",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "COORDINATOR PHARMACY OPERATIONS",
        "authorized_official_telephone_number": "218-786-4265",
        "authorized_official_credential": "MT BA"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Medication Therapy Management Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.