ESSENTIA HEALTH LAKESIDE CLINIC – NPI #1245278936
Clinic/Center

ESSENTIA HEALTH LAKESIDE CLINIC is an AHC clinic located in DULUTH, MN. NPPES has assigned the NPI number 1245278936 to ESSENTIA HEALTH LAKESIDE CLINIC on June 03, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “ESSENTIA HEALTH LAKESIDE CLINIC” is a dba name, the actual legal business name for this organization is THE DULUTH CLINIC, LTD. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QM1300X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Multi-Specialty

The NPI profile was previously updated about 2 years ago on Feb 28, 2024. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for ESSENTIA HEALTH LAKESIDE CLINIC below.

NPI Profile for
THE DULUTH CLINIC, LTD

NPI Number
1245278936
Enumeration Date

(more than 20 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
THE DULUTH CLINIC, LTD
Doing Business As (dba): ESSENTIA HEALTH LAKESIDE CLINIC
Primary location
4621 E SUPERIOR ST
DULUTH, MN 55804-2338
Phone: (218) 786-3550 Fax:
Mailing address
Same as primary location
Organization Subpart
Yes - ESSENTIA HEALTH LAKESIDE CLINIC is subpart of another organization.
Authorized Official
KEVIN BOREN
VP OF FINANCE
Phone: (218) 786-1009
Updated
Certification Date
Feb 28, 2024

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for ESSENTIA HEALTH LAKESIDE CLINIC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidMN1245278936
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QM1300X
- Clinic/Center / Multi-Specialty (Primary)
332B00000X
- Durable Medical Equipment & Medical Supplies

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.