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General NPI Number Information
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NPI Number | 1790848992
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Entity Type | Organization
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Legal Business Name | MAYO CLINIC HEALTH SYSTEM-SOUTHEAST MINNESOTA REGION
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 1000 1ST DR NW
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City | AUSTIN
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State | MN
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Zip | 55912-2941
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Country | US
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Telephone | 507-434-1422
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Fax | 507-422-1035
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Provider Business Mailing Address
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Address Line | 1000 1ST DR NW
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City | AUSTIN
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State | MN
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Zip | 55912-2941
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Country | US
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Telephone | 507-434-1422
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Fax | 507-422-1035
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | CHARLOTTE NORDRUM
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Credential |
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Telephone | 507-594-2646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 264085
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License Number State | MN
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