Provider Demographics
NPI:1538107594
Name:ESSENTIA HEALTH VIRGINIA, LLC
Entity Type:Organization
Organization Name:ESSENTIA HEALTH VIRGINIA, LLC
Other - Org Name:ESSENTIA HEALTH BABBITT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-749-9496
Mailing Address - Street 1:71 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:BABBITT
Mailing Address - State:MN
Mailing Address - Zip Code:55706-3702
Mailing Address - Country:US
Mailing Address - Phone:218-827-2176
Mailing Address - Fax:
Practice Address - Street 1:71 SOUTH DR
Practice Address - Street 2:
Practice Address - City:BABBITT
Practice Address - State:MN
Practice Address - Zip Code:55706-3702
Practice Address - Country:US
Practice Address - Phone:218-827-2176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MARY'S DULUTH CLINIC HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-03
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1538107594Medicaid
MN1538107594Medicaid
MNC09302Medicare PIN
MNC06444Medicare PIN