1366420788 NPI number — MAYO CLINIC HEALTH SYSTEM-SOUTHWEST WISCONSIN REGION, INC.

Table of content: (NPI 1366420788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366420788 NPI number — MAYO CLINIC HEALTH SYSTEM-SOUTHWEST WISCONSIN REGION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYO CLINIC HEALTH SYSTEM-SOUTHWEST WISCONSIN REGION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FRANCISCAN HEALTHCARE - SPARTA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366420788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 860056
Provider Second Line Business Mailing Address:
ATTN: REVENUE RECOGNITION & COMPLIANCE
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55486-0056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-791-4156
Provider Business Mailing Address Fax Number:
608-392-9518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-269-1770
Provider Business Practice Location Address Fax Number:
608-269-1017
Provider Enumeration Date:
01/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BORTNEM
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANICIAL OFFICER
Authorized Official Telephone Number:
715-838-5270

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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