Healthcare Provider Details

I. General information

NPI: 1487691531
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: 05/31/2006
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 STOUT RD
MENOMONIE WI
54751-7003
US

IV. Provider business mailing address

2321 STOUT RD
MENOMONIE WI
54751-7003
US

V. Phone/Fax

Practice location:
  • Phone: 715-235-5531
  • Fax: 715-233-7755
Mailing address:
  • Phone: 715-235-5531
  • Fax: 715-233-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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