Provider Demographics
NPI: | 1235666967 |
---|---|
Name: | MAYO CLINIC HEALTH SYSTEM-NORTHWEST WISCONSIN REGION, INC. |
Entity Type: | Organization |
Organization Name: | MAYO CLINIC HEALTH SYSTEM-NORTHWEST WISCONSIN REGION, INC. |
Other - Org Name: | MAYO CLINIC HEALTH SYSTEM-RED CEDAR, |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JULIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HANSEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 715-838-5270 |
Mailing Address - Street 1: | 2321 STOUT RD |
Mailing Address - Street 2: | |
Mailing Address - City: | MENOMONIE |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 54751-7003 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 715-235-5531 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2321 STOUT RD |
Practice Address - Street 2: | |
Practice Address - City: | MENOMONIE |
Practice Address - State: | WI |
Practice Address - Zip Code: | 54751-7003 |
Practice Address - Country: | US |
Practice Address - Phone: | 715-235-5531 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-05-12 |
Last Update Date: | 2017-05-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |