Basic Information
| Provider Information | |||||||||
| NPI: | 1881121648 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAYO CLINIC HEALTH SYSTEM-SOUTHWEST MINNESOTA REGION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MAYO CLINIC HEALTH SYSTEM-FAIRMONT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 2ND ST SW STE 118 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559023197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072843390 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | FAIRMONT | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560314575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072388100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 09/22/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BRANDT | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHAIR ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 5073856562 | ||||||||
| 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.