Provider Demographics
NPI:1982641791
Name:THE DULUTH CLINIC, LTD
Entity Type:Organization
Organization Name:THE DULUTH CLINIC, LTD
Other - Org Name:ESSENTIA HEALTH AURORA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EX. VP & SR. OFFICER DC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-786-2625
Mailing Address - Street 1:405 W 3RD AVE N
Mailing Address - Street 2:BOX 392
Mailing Address - City:AURORA
Mailing Address - State:MN
Mailing Address - Zip Code:55705-1247
Mailing Address - Country:US
Mailing Address - Phone:218-229-3311
Mailing Address - Fax:
Practice Address - Street 1:405 W 3RD AVE N
Practice Address - Street 2:BOX 392
Practice Address - City:AURORA
Practice Address - State:MN
Practice Address - Zip Code:55705-1247
Practice Address - Country:US
Practice Address - Phone:218-229-3311
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:2006-06-01
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN230814200Medicaid
0440980011Medicare NSC
MN230814200Medicaid