Healthcare Provider Details

I. General information

NPI: 1932428547
Provider Name (Legal Business Name): MAYO FOUNDATION FOR MED EDUCATION & RSCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 2ND ST SW BRACKENRIDGE BUILDING, LOWER LEVEL
ROCHESTER MN
55902-3026
US

IV. Provider business mailing address

PO BOX 083268
CHICAGO IL
60691-0268
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2021
  • Fax: 507-538-1314
Mailing address:
  • Phone: 507-284-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number260408
License Number StateMN

VIII. Authorized Official

Name: MS. ANDREA SWANSON
Title or Position: DIRECTOR
Credential:
Phone: 507-538-1680