Provider Demographics
NPI:1457302234
Name:MAYO CLINIC HEALTH SYSTEM-SOUTHWEST WISCONSIN REGION, INC.
Entity Type:Organization
Organization Name:MAYO CLINIC HEALTH SYSTEM-SOUTHWEST WISCONSIN REGION, INC.
Other - Org Name:MAYO CLINIC HEALTH SYSTEM FRANCISCAN HEALTHCARE - SPARTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANICIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BORTNEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-838-5270
Mailing Address - Street 1:PO BOX 860056
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0056
Mailing Address - Country:US
Mailing Address - Phone:608-392-3885
Mailing Address - Fax:906-392-9518
Practice Address - Street 1:400 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-2115
Practice Address - Country:US
Practice Address - Phone:608-269-1770
Practice Address - Fax:608-269-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI741920003Medicare ID - Type Unspecified