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General NPI Number Information
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NPI Number | 1356576896
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Entity Type | Organization
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Legal Business Name | MAYO CLINIC HEALTH SYSTEM-SOUTHWEST WISCONSIN REGION, INC.
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 1303 S MAIN ST
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City | HOLMEN
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State | WI
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Zip | 54636-8927
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Country | US
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Telephone | 608-526-1566
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Fax | 608-526-1554
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Provider Business Mailing Address
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Address Line | PO BOX 860568
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City | MINNEAPOLIS
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State | MN
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Zip | 55486-0524
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Country | US
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Telephone | 608-392-3988
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Fax | 608-392-9180
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MARK BORTNEM
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Credential |
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Telephone | 715-838-5270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 893042
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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