Healthcare Provider Details

I. General information

NPI: 1306992474
Provider Name (Legal Business Name): MAYO CLINIC HEALTH SYSTEM-NORTHWEST WISCONSIN REGION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 E WOODLAND AVE
BARRON WI
54812-1765
US

IV. Provider business mailing address

1222 E WOODLAND AVE
BARRON WI
54812-1765
US

V. Phone/Fax

Practice location:
  • Phone: 715-537-3166
  • 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: JULIE SCHAUS HANSEN
Title or Position: CFO
Credential:
Phone: 715-838-5270