Provider Demographics
NPI:1649223629
Name:ST. LUKE'S HOSPITAL OF DULUTH
Entity Type:Organization
Organization Name:ST. LUKE'S HOSPITAL OF DULUTH
Other - Org Name:ST. LUKE'S PAVILION SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
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 1:920 E 1ST ST
Mailing Address - Street 2:SUITE P-101
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2201
Mailing Address - Country:US
Mailing Address - Phone:218-279-6200
Mailing Address - Fax:218-279-6205
Practice Address - Street 1:920 E 1ST ST
Practice Address - Street 2:SUITE P-101
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2201
Practice Address - Country:US
Practice Address - Phone:218-279-6200
Practice Address - Fax:218-279-6205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN090973400Medicaid
MNC02958Medicare PIN