Basic Information
| Provider Information | |||||||||
| NPI: | 1174866990 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAYO CLINIC HEALTH SYSTEM - FRANCISCAN MEDICAL CENTER INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MAYO CLINIC HEALTH SYSTEM FRANCISCAN HEALTHCARE-WAUKON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 860056 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554860056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083923885 | ||||||||
| FaxNumber: | 6083929518 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 EAST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | WAUKON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 546601412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083725999 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2013 | ||||||||
| LastUpdateDate: | 03/29/2013 | ||||||||
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| AuthorizedOfficialLastName: | TIGGELAR | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT/CFO | ||||||||
| AuthorizedOfficialTelephone: | 6087914144 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.