Healthcare Provider Details

I. General information

NPI: 1548283435
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: 07/25/2006
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 WESTGATE RD STE 1
EAU CLAIRE WI
54703-4964
US

IV. Provider business mailing address

PO BOX 860092
MINNEAPOLIS MN
55486-0092
US

V. Phone/Fax

Practice location:
  • Phone: 715-838-5861
  • Fax:
Mailing address:
  • Phone: 715-838-5856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number8530
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

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