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General NPI Number Information
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NPI Number | 1760529119
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Entity Type | Organization
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Legal Business Name | MAYO CLINIC HEALTH SYSTEM-SOUTHWEST MINNESOTA REGION
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 301 2ND ST NE
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City | NEW PRAGUE
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State | MN
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Zip | 56071-1709
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Country | US
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Telephone | 952-653-2528
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Fax |
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Provider Business Mailing Address
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Address Line | 6501 CITY WEST PKWY
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-3248
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHAIR ADMINISTRATION
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Name | TERRY BRANDT
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Credential |
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Telephone | 507-385-6562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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