Basic Information
| Provider Information | |||||||||
| NPI: | 1013933936 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. MARY'S MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558051950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187864000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 407 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558051950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187864000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 08/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | OLSON | ||||||||
| AuthorizedOfficialFirstName: | MARIBETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICE AND ADM. | ||||||||
| AuthorizedOfficialTelephone: | 2187864790 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. MARY'S DULUTH CLINIC HEALTH SYSTEM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | 331095 | MN | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.