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RRC240047-23 ST. LUKES HOSPITAL OF DULUTH (Terminated)
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Main Details
Name
ST. LUKES HOSPITAL OF DULUTH
Subdivision Name
Aspirus St. Luke's Clinic - Duluth - Interventional Pain Management - 1015 E 1st St - Pain Management
Type
Rural Referral Center
Rural
Yes
340B ID
RRC240047-23
Medicare Provider Number
240047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/23/2024
Last Recertification Date
Termination Date
Termination Reason
1/1/2025
Other
Contacts
Authorizing Official
St. Luke's Hospital of Duluth
Michael Boeselager, Vice President Support Services
(218) 249-2459
Primary Contact
St. Luke's Hospital of Duluth
Katherine Becker, Vice President Corporate Compliance
(218) 249-5357
Addresses
Street Address
1015 E 1st St
Level 4
Duluth, MN 55805
Billing Address
St. Luke's Hospital of Duluth
915 E 1st St
Duluth, MN 55805
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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