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General NPI Number Information
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NPI Number | 1972552909
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Entity Type | Organization
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Legal Business Name | MAYO CLINIC HEALTH SYSTEM-NORTHWEST WISCONSIN REGION, INC.
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 3845 LONDON RD
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City | EAU CLAIRE
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State | WI
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Zip | 54701-7815
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Country | US
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Telephone | 715-838-5270
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 WHIPPLE ST
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City | EAU CLAIRE
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State | WI
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Zip | 54703-5270
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Country | US
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Telephone | 715-838-5270
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Fax |
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Authorized Official
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Title or Position | CFO
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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 | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 1990
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License Number State | WI
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