Provider Demographics
NPI:1851310247
Name:MAYO CLINIC HEALTH SYSTEM-SOUTHEAST MINNESOTA REGION
Entity Type:Organization
Organization Name:MAYO CLINIC HEALTH SYSTEM-SOUTHEAST MINNESOTA REGION
Other - Org Name:MAYO CLINIC HEALTH SYSTEM-ALBERT LEA AND AUSTIN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
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:715-838-5270
Mailing Address - Street 1:1000 1ST DR NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2941
Mailing Address - Country:US
Mailing Address - Phone:507-433-7351
Mailing Address - Fax:
Practice Address - Street 1:101 14TH ST NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912
Practice Address - Country:US
Practice Address - Phone:507-434-1415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330991251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
241544Medicare Oscar/Certification
241544Medicare Oscar/Certification
IA0994459Medicaid
IA0517656Medicaid