| Duluthtms, Llc | |
|
202 N 24th Ave E Duluth MN 55812-1859 | |
| (612) 423-3238 | |
| Not Available |
| Full Name | Duluthtms, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 202 N 24th Ave E, Duluth, Minnesota |
| Authorized Official Name and Position | Eric A Johnson (SOLO MEMBER) |
| Authorized Official Contact | 6124233238 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Duluthtms, Llc 202 N 24th Ave E Duluth MN 55812-1859 Ph: (612) 423-3238 | Duluthtms, Llc 202 N 24th Ave E Duluth MN 55812-1859 Ph: (612) 423-3238 |
| NPI Number | 1356876163 |
|---|---|
| Provider Enumeration Date | 04/29/2017 |
| Last Update Date | 04/29/2017 |
| Medicare PECOS PAC ID | 0749558104 |
|---|---|
| Medicare Enrollment ID | O20170608000805 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356876163 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 41189 (Minnesota) | Primary |
| Provider Name | Eric A Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750464640 PECOS PAC ID: 5991783185 Enrollment ID: I20040713001027 |
| Provider Name | Piyush Das |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1265639140 PECOS PAC ID: 7214060763 Enrollment ID: I20100804000287 |
| Provider Name | Leah S Good |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376068684 PECOS PAC ID: 4385901404 Enrollment ID: I20171128002281 |
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