Basic Information
| Provider Information | |||||||||
| NPI: | 1366420788 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER, INC. | ||||||||
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| OtherOrganizationName: | FRANCISCAN HEALTHCARE - SPARTA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 860056 | ||||||||
| Address2: | ATTN: REVENUE RECOGNITION & COMPLIANCE | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554860056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087914156 | ||||||||
| FaxNumber: | 6083929518 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 WEST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082691770 | ||||||||
| FaxNumber: | 6082691017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | BORTNEM | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANICIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7158385270 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.