NPIMap

Organization Active NPI

Home Dialysis Duluth Kidney Services

  • Nephrology Physician
  • Duluth, MN
National Provider Identifier
1629287792
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
35304 Issued in MN
Legal business name
HOME DIALYSIS DULUTH KIDNEY SERVICES
Practice address
925 E Superior St
Suite 106
Duluth, MN 55802-2238
Phone
(218) 249-6230
Fax
(218) 249-6231
NPI assigned
May 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Sandy Sue Popham, M.D.
Title
Owner
Phone
(218) 249-6230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X 35304 MN Primary

Addresses

Primary practice location

925 E Superior St
Suite 106
Duluth, MN 55802-2238

Mailing address

925 E Superior St
Suite 106
Duluth, MN 55802-2238
Phone (218) 249-6230

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629287792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 E SUPERIOR ST",
            "address_2": "SUITE 106",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022238",
            "telephone_number": "218-249-6230",
            "fax_number": "218-249-6231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 E SUPERIOR ST",
            "address_2": "SUITE 106",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022238",
            "telephone_number": "218-249-6230",
            "fax_number": "218-249-6231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME DIALYSIS DULUTH KIDNEY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POPHAM",
        "authorized_official_first_name": "SANDY",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-249-6230",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "MN",
            "license": "35304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 2020; 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.