Basic Information
| Provider Information | |||||||||
| NPI: | 1679161384 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAYO CLINIC HEALTH SYSTEM-SOUTHWEST MINNESOTA REGION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 STATE ST N | ||||||||
| Address2: | |||||||||
| City: | WASECA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560932811 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 STATE ST N | ||||||||
| Address2: | |||||||||
| City: | WASECA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560932811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5078351210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2021 | ||||||||
| LastUpdateDate: | 01/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | MEKALA | ||||||||
| AuthorizedOfficialFirstName: | PRAVEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5072661557 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MAYO CLINIC HEALTH SYSTEM-SOUTHWEST MINNESOTA REGION | ||||||||
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| NPICertificationDate: | 01/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.