Provider Demographics
NPI:1033161161
Name:ST. LUKE'S HOSPITAL OF DULUTH
Entity Type:Organization
Organization Name:ST. LUKE'S HOSPITAL OF DULUTH
Other - Org Name:ASPIRUS ST. LUKE'S CLINIC - GRAND AVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-249-5555
Mailing Address - Street 1:4702 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2742
Mailing Address - Country:US
Mailing Address - Phone:218-249-6800
Mailing Address - Fax:
Practice Address - Street 1:4702 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2742
Practice Address - Country:US
Practice Address - Phone:218-249-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCD9674Medicare PIN
MNC06028Medicare PIN