Provider Demographics
NPI:1417923475
Name:MAYO FOUNDATION FOR MEDICAL EDUCATION & RESEARCH
Entity Type:Organization
Organization Name:MAYO FOUNDATION FOR MEDICAL EDUCATION & RESEARCH
Other - Org Name:THE MAYO CLINIC STORE - SIEBENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:DAHLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-266-4416
Mailing Address - Street 1:PO BOX 083268
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60691-0268
Mailing Address - Country:US
Mailing Address - Phone:507-284-3390
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:SUITE SL123
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-9669
Practice Address - Fax:507-538-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN530727900Medicaid
0297530002Medicare NSC