Provider Demographics
NPI:1629017793
Name:ST. LUKE'S HOSPITAL OF DULUTH
Entity Type:Organization
Organization Name:ST. LUKE'S HOSPITAL OF DULUTH
Other - Org Name:MARINER OUTPATIENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-249-5475
Mailing Address - Street 1:109 N 28TH ST E
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-6548
Mailing Address - Country:US
Mailing Address - Phone:715-395-3900
Mailing Address - Fax:
Practice Address - Street 1:109 N 28TH ST E
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-6548
Practice Address - Country:US
Practice Address - Phone:715-395-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI18095Medicare PIN
MN240047Medicare Oscar/Certification
WICE8276Medicare PIN