Provider Demographics
NPI:1639198732
Name:MAYO CLINIC HEALTH SYSTEM ST. JAMES
Entity Type:Organization
Organization Name:MAYO CLINIC HEALTH SYSTEM ST. JAMES
Other - Org Name:
Other - Org Type:
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 1:1101 MOULTON AND PARSONS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MN
Mailing Address - Zip Code:56081-5550
Mailing Address - Country:US
Mailing Address - Phone:507-375-3261
Mailing Address - Fax:507-375-8605
Practice Address - Street 1:1101 MOULTON AND PARSONS DR
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-5550
Practice Address - Country:US
Practice Address - Phone:507-375-3261
Practice Address - Fax:507-375-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330835282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN241333Medicare ID - Type Unspecified