Provider Demographics
NPI:1255498432
Name:CANNON FALLS MEDICAL CENTER
Entity Type:Organization
Organization Name:CANNON FALLS MEDICAL CENTER
Other - Org Name:MAYO HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NIEBUR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ATC
Authorized Official - Phone:651-253-4118
Mailing Address - Street 1:2556 YELLOWSTONE RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-3751
Mailing Address - Country:US
Mailing Address - Phone:651-253-4118
Mailing Address - Fax:
Practice Address - Street 1:1116 MILL ST W
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-1824
Practice Address - Country:US
Practice Address - Phone:507-263-4221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1957282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural