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General NPI Number Information
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NPI Number | 1538113022
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Entity Type | Organization
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Legal Business Name | MAYO CLINIC HEALTH SYSTEM-LAKE CITY
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 500 W GRANT ST
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City | LAKE CITY
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State | MN
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Zip | 55041-1143
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Country | US
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Telephone | 651-345-3321
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Fax | 651-345-1151
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Provider Business Mailing Address
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Address Line | 500 W GRANT ST
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City | LAKE CITY
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State | MN
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Zip | 55041-1143
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Country | US
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Telephone | 651-345-3321
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Fax | 651-345-1151
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Authorized Official
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Title or Position | CFO
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Name | PRAVEEN MEKALA
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Credential |
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Telephone | 507-594-6449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number |
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License Number State | MN
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