Healthcare Provider Details

I. General information

NPI: 1063435410
Provider Name (Legal Business Name): MAYO CLINIC HEALTH SYSTEM-SOUTHEAST MINNESOTA REGION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
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 24 BLVD
CANNON FALLS MN
55009-5003
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 Code282NC0060X
TaxonomyCritical Access Hospital
License Number331884
License Number StateMN

VIII. Authorized Official

Name: PRAVEEN MEKALA
Title or Position: CFO
Credential:
Phone: 507-594-6449