Healthcare Provider Details

I. General information

NPI: 1790791077
Provider Name (Legal Business Name): MAYO CLINIC HEALTH SYSTEM-SOUTHEAST MINNESOTA REGION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32021 COUNTY ROAD 24 BLVD.
CANNON FALLS MN
55009
US

IV. Provider business mailing address

32021 COUNTY ROAD 24 BLVD.
CANNON FALLS MN
55009
US

V. Phone/Fax

Practice location:
  • Phone: 507-263-6000
  • Fax:
Mailing address:
  • Phone: 507-263-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: PRAVEEN MEKALA
Title or Position: CHEIF FINANCIAL OFFICER
Credential:
Phone: 507-594-6449