1417923475 NPI number — MAYO FOUNDATION FOR MEDICAL EDUCATION & RESEARCH

Table of content: (NPI 1417923475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417923475 NPI number — MAYO FOUNDATION FOR MEDICAL EDUCATION & RESEARCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYO FOUNDATION FOR MEDICAL EDUCATION & RESEARCH
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:
THE MAYO CLINIC STORE - SIEBENS
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:
1417923475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 083268
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60691-0268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-284-3390
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 1ST ST SW
Provider Second Line Business Practice Location Address:
SUITE SL123
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55905-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-284-9669
Provider Business Practice Location Address Fax Number:
507-538-1314
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAHLEN
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
507-266-4416

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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