Healthcare Provider Details

I. General information

NPI: 1366410862
Provider Name (Legal Business Name): MAYO CLINIC HEALTH SYSTEM-FAIRMONT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEDICAL CENTER DR
FAIRMONT MN
56031-4575
US

IV. Provider business mailing address

800 MEDICAL CENTER DR
FAIRMONT MN
56031-4575
US

V. Phone/Fax

Practice location:
  • Phone: 507-238-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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