Healthcare Provider Details

I. General information

NPI: 1871630855
Provider Name (Legal Business Name): MAYO CLINIC HEALTH SYSTEM-SOUTHWEST MINNESOTA REGION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 STATE ST N
WASECA MN
56093-2811
US

IV. Provider business mailing address

6501 CITY WEST PKWY
EDEN PRAIRIE MN
55344-3248
US

V. Phone/Fax

Practice location:
  • Phone: 952-653-2528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: TERRY BRANDT
Title or Position: CHAIR ADMINISTRATION
Credential:
Phone: 507-385-6562