NPIMap

Organization Active NPI

Federal Prison Camp Duluth

  • Community/Behavioral Health Agency
  • Duluth, MN
National Provider Identifier
1982971271
Registry record updated Nov 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
FEDERAL PRISON CAMP DULUTH
Practice address
4464 Ralston Dr
Duluth, MN 55811-1519
Phone
(218) 249-7452
NPI assigned
Nov 30, 2011
Last updated
Nov 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2011

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

Authorized official

Name
Dr. Traci Sue Amundson, PSY.D.
Title
Chief Psychologist
Phone
(218) 249-7452

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

4464 Ralston Dr
Duluth, MN 55811-1519

Mailing address

4464 Ralston Drive
Duluth, MN 55811-1519
Phone (218) 249-7452

Other names 1

  • Bureau of Prisons Other name

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0705269Federal Prison Camp Duluth4464 Ralston Drive, Duluth, MN 55811Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Fci Texarkana49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

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

View all 48

Locations

4464 Ralston Dr
Duluth, MN 55811
Phone (218) 249-7452

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1322611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322611200000",
    "number": "1982971271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4464 RALSTON DRIVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558111519",
            "telephone_number": "218-249-7452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4464 RALSTON DR",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558111519",
            "telephone_number": "218-249-7452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FEDERAL PRISON CAMP DULUTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-30",
        "last_updated": "2011-11-30",
        "status": "A",
        "authorized_official_last_name": "AMUNDSON",
        "authorized_official_first_name": "TRACI",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "CHIEF PSYCHOLOGIST",
        "authorized_official_telephone_number": "218-249-7452",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bureau of Prisons",
            "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 Nov 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.