Healthcare Provider Details

I. General information

NPI: 1104587765
Provider Name (Legal Business Name): MAYO COLLABORATIVE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 41ST ST NW
ROCHESTER MN
55901-8901
US

IV. Provider business mailing address

PO BOX 4100
ROCHESTER MN
55903-4100
US

V. Phone/Fax

Practice location:
  • Phone: 800-447-6424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DENNIS EUGENE DAHLEN
Title or Position: CFO
Credential:
Phone: 507-266-4416