SMDC MEDICAL CENTER (NPI# 1235488438) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235488438 |
| Entity Type | Organization |
| Organization Name | SMDC MEDICAL CENTER |
| Other Organization Name | ESSENTIA HEALTH DULUTH-AMBERWING CLINIC |
| Practice Address |
615 Pecan Ave Duluth MN 55811 |
| Practice Telephone | 2183552100 |
| Practice Fax Number | 2183552105 |
| Mailing Telephone | 2183552100 |
| Mailing Fax Number | 2183552105 |
| Enumeration Date | 2012-09-04 |
| Last Update Date | 2018-06-13 |
| Authorized Official Name | KEVIN BOREN (CFO) |
| Authorized Official Telephone | 2187861009 |
| Is Organization Subpart | Y |
| Parent Organization Name | ST. MARY'S DULUTH CLINIC HEALTH SYSTEM |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 1033153895 | 05 |
| Other Name | Type Code |
|---|---|
| Essentia Health Duluth-Amberwing Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518988310 | Smdc Medical Center | Rehabilitation Unit | 502 E 2nd St, Duluth, MN 55805-1913 | 2006-07-21 |
| 1033153895 | Smdc Medical Center | General Acute Care Hospital | 502 E 2nd St, Duluth, MN 55805-1913 | 2006-06-15 |
| Street Address |
615 PECAN AVE |
| City | DULUTH |
| State | MN |
| Zip Code | 55811 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780882944 | Mary Soule Geidner | Social Worker | 615 Pecan Ave, Duluth, MN 55811-2749 | 2007-07-10 |
| 1780201657 | Alyssa Dye | Nurse Practitioner | 615 Pecan Ave, Duluth, MN 55811-2749 | 2020-06-26 |
| 1366079816 | Eileen Huggins | Social Worker | 615 Pecan Ave, Duluth, MN 55811-2749 | 2020-03-25 |
| 1629494174 | Sigurd Haller | Social Worker | 615 Pecan Ave, Duluth, MN 55811-2749 | 2014-03-07 |
| 1801030366 | Maren Elizabeth Barootian | Social Worker | 615 Pecan Ave, Duluth, MN 55811 | 2009-04-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417515339 | Kyle Olson-merrick | Dentist | 320 W Myrtle St, Ste 100, Duluth, MN 55811 | 2019-06-05 |
| 1184288979 | Pdg, P.a. | Clinic/Center | 4891 Miller Truck Hwy., Suite 100, Hermantown, MN 55811 | 2019-04-26 |
| 1528589843 | Breanna Joy Greenly | Counselor | 4720 Burning Tree Road, Birch Tree Center, Duluth, MN 55811 | 2017-06-28 |
| 1396102398 | Debbie Christian | Registered Nurse | 4815 Burning Tree Rd Suite 100, Duluth, MN 55811 | 2016-01-21 |
| 1831556935 | Megan Marie Paris | Psychologist | 715 East Central Entrance, Duluth, MN 55811 | 2016-01-20 |
| 1740666908 | Angela Fedo | Physical Therapy Assistant | 2101 Trinity Rd, Duluth, MN 55811 | 2015-08-10 |
| 1649657479 | Kayla Stephenson | Specialist/Technologist | 5024 Morris Thomas Road, Hermantown, MN 55811 | 2015-04-30 |
| 1073918843 | Northern Lives Inc. | Assisted Living Facility | 4014 Trinity Road, Duluth, MN 55811 | 2014-10-23 |
| 1114326238 | Donald Hermanson | Specialist/Technologist | 801 Boulder Drive, Apt. 202, Duluth, MN 55811 | 2014-08-14 |
| 1679990857 | Jodie Little | Pharmacist | 801 W. Central Entrance, Shopko Pharmacy 2114, Duluth, MN 55811 | 2014-03-25 |
| Find all providers in zip 55811 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407949167 | The Hills Youth and Family Services | Clinic/Center | 4321 Allendale Avenue, Duluth, MN 55803 | 2006-10-02 |
| 1255896668 | The Serenity Foundation of Seven, Inc | Clinic/Center | 2180 Satellite Blvd Ste 400, Duluth, GA 30097-4927 | 2019-02-10 |
| 1154642262 | Inner Fokus | Clinic/Center | 301 W 1st St, Suite 503, Duluth, MN 55802-1613 | 2010-06-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821697202 | Kids Zone Autism Center Inc | Clinic/Center | 670 Marigold Ter Ne, Fridley, MN 55432-5641 | 2020-10-18 |
| 1568079374 | Midway Counseling Services LLC | Clinic/Center | 1410 9th Ave S Apt 306, Saint Cloud, MN 56301-5787 | 2020-09-25 |
| 1801409099 | Star Autism Center | Clinic/Center | 3333 W Division St Ste 116, Saint Cloud, MN 56301-4548 | 2020-08-26 |
| 1851900484 | Iron Range Behavioral Services LLC | Clinic/Center | 817 S 5th Ave, Virginia, MN 55792-2804 | 2020-07-29 |
| 1184240103 | Adhd&u | Clinic/Center | 2196 Carter Ave, Saint Paul, MN 55108-1709 | 2020-06-25 |
| 1033744008 | Star Health Services | Clinic/Center | 3055 Old High 8, Saint Anthony, MN 55418 | 2020-03-10 |
| 1659906071 | Amoud Center Inc | Clinic/Center | 1925 Portland Ave, Minneapolis, MN 55404-2713 | 2020-03-05 |
| 1164055026 | Moonlight Support Services LLC | Clinic/Center | 3110 Old Hwy 8, 206, Roseville, MN 55113-5511 | 2020-02-19 |
| 1285279554 | Metro Therapy Center Inc | Clinic/Center | 2520 Pillsbury Ave S Apt 306, Minneapolis, MN 55404-4208 | 2019-11-11 |
| 1710536081 | Blu Care Inc | Clinic/Center | 2910 Pillsbury Ave S Ste 338, Minneapolis, MN 55408 | 2019-09-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.