MEDICARE: MAYO CLINIC HEALTH SYSTEM-SOUTHWEST WISCONSIN REGION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1972091361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYO CLINIC HEALTH SYSTEM-SOUTHWEST WISCONSIN REGION, INC.

Provider Business Mailing Address
First Line	:	895 DETTLOFF DR
Second Line	:
City	:	ARCADIA
State	:	WI
Zip	:	54612-2600
Country	:	US
Telephone Number	:	608-323-3373
Fax Number	:

Provider Business Practice Location Address
First Line	:	895 DETTLOFF DR
Second Line	:
City	:	ARCADIA
State	:	WI
Zip	:	54612-2600
Country	:	US
Telephone Number	:	608-323-3373
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MARK BORTNEM
Credential	:
Telephone Number	:	715-838-5270

Provider Enumeration Date	:	05/01/2018
Last Update Date	:	08/15/2025

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