1891758314 NPI number — LABORATORY MEDICINE SPECIALISTS OF DULUTH

Table of content: (NPI 1891758314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891758314 NPI number — LABORATORY MEDICINE SPECIALISTS OF DULUTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORY MEDICINE SPECIALISTS OF DULUTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891758314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 E 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55805-2107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-249-5208
Provider Business Mailing Address Fax Number:
218-726-3007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1346 W ARROWHEAD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55811-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-288-8325
Provider Business Practice Location Address Fax Number:
218-726-3007
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUNDEEN
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
800-288-8325

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 854 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 218893600 . This is a "US POSTAL SERVICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2098 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3986 . This is a "ATRIUM GROUP HEALTH" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1133017 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 10447D011 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 42512LA . This is a "BLUES" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 32787100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 596145 . This is a "AMERICA PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 342312300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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