Healthcare Provider Details

I. General information

NPI: 1639109176
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: 07/03/2006
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 THOMPSON ST
BLOOMER WI
54724-1257
US

IV. Provider business mailing address

1501 THOMPSON ST
BLOOMER WI
54724-1257
US

V. Phone/Fax

Practice location:
  • Phone: 715-568-2000
  • Fax:
Mailing address:
  • Phone: 715-568-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number1017
License Number StateWI

VIII. Authorized Official

Name: MARK BORTNEM
Title or Position: CFO
Credential:
Phone: 715-838-5270