MEDICARE: MAYO CLINIC ARIZONA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0002X	Clinic Pharmacy	Y006569	AZ
3	3336I0012X	Institutional Pharmacy
4	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2155895	OTHER		PK

General Provider Information

NPI Number	:	1255796496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYO CLINIC ARIZONA

Provider Business Mailing Address
First Line	:	PO BOX 083268
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60691-0268
Country	:	US
Telephone Number	:	507-284-3390
Fax Number	:

Provider Business Practice Location Address
First Line	:	5881 E MAYO BLVD
Second Line	:	# STE 1-304
City	:	PHOENIX
State	:	AZ
Zip	:	85054-4505
Country	:	US
Telephone Number	:	480-342-4100
Fax Number	:	480-342-4180

Authorized Official
Title or Position	:	CAO
Name	:	ROSHANAK DIDEHBAN
Credential	:
Telephone Number	:	480-301-6493

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	08/11/2025

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Directions to “MAYO CLINIC ARIZONA ” Practice Location

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