Provider Demographics
NPI:1891758314
Name:LABORATORY MEDICINE SPECIALISTS OF DULUTH
Entity Type:Organization
Organization Name:LABORATORY MEDICINE SPECIALISTS OF DULUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-249-5208
Mailing Address - Street 1:915 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2107
Mailing Address - Country:US
Mailing Address - Phone:218-249-5208
Mailing Address - Fax:218-726-3007
Practice Address - Street 1:1346 W ARROWHEAD RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2218
Practice Address - Country:US
Practice Address - Phone:218-249-5208
Practice Address - Fax:218-726-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN854291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN42512LAOtherBLUES
MN1133017OtherMEDICA
MN2098OtherHEALTHPARTNERS
MN596145OtherAMERICA PPO
MN10447D011OtherUCARE
WI32787100Medicaid
WI3986OtherATRIUM GROUP HEALTH
WI32787100Medicaid
MN=========OtherPREFERRED ONE
WI32787100Medicaid