Provider Demographics
NPI:1124035282
Name:MAYO CLINIC HEALTH SYSTEM-SOUTHWEST MINNESOTA REGION
Entity Type:Organization
Organization Name:MAYO CLINIC HEALTH SYSTEM-SOUTHWEST MINNESOTA REGION
Other - Org Name:MAYO CLINIC HEALTH SYSTEM-NEW PRAGUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEKALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-594-6449
Mailing Address - Street 1:301 2ND STREET NE
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071
Mailing Address - Country:US
Mailing Address - Phone:952-758-4431
Mailing Address - Fax:952-758-7876
Practice Address - Street 1:301 2ND STREET NE
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071
Practice Address - Country:US
Practice Address - Phone:952-758-4431
Practice Address - Fax:952-758-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN241361Medicare PIN