Healthcare Provider Details

I. General information

NPI: 1841278637
Provider Name (Legal Business Name): MAYO CLINIC HEALTH SYSTEM-SOUTHWEST WISCONSIN REGION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W MAIN ST
SPARTA WI
54656-2170
US

IV. Provider business mailing address

PO BOX 860056 ATTN: REVENUE RECOGNITION & COMPLIANCE
MINNEAPOLIS MN
55486-0056
US

V. Phone/Fax

Practice location:
  • Phone: 608-269-2132
  • Fax: 608-269-4562
Mailing address:
  • Phone: 608-392-4156
  • Fax: 608-392-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number1009
License Number StateWI

VIII. Authorized Official

Name: MARK BORTNEM
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 715-838-5270