| Details | Last Recertification Date | Update | Recertification | 2/1/2024 2:19:48 PM | 2/10/2025 1:53:59 PM | 2/10/2025 1:53 PM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2023 8:52:33 AM | 2/1/2024 2:19:48 PM | 2/1/2024 2:19 PM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2022 9:17:57 AM | 1/31/2023 8:52:33 AM | 1/31/2023 8:52 AM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2021 11:19:42 AM | 2/1/2022 9:17:57 AM | 2/1/2022 9:17 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2020 10:24:46 AM | 2/9/2021 11:19:42 AM | 2/9/2021 11:19 AM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2019 8:31:22 AM | 1/30/2020 10:24:46 AM | 1/30/2020 10:24 AM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2018 9:54:44 AM | 2/7/2019 8:31:22 AM | 2/7/2019 8:31 AM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2017 12:00:00 AM | 2/8/2018 9:54:44 AM | 2/8/2018 9:54 AM |
| Contacts | Primary Contact | Update | Change Request | Lunn, Lane
Chief Executive Officer
North Florida Medical Centers,Inc
8502986001 | Mayo, Matthew R
Privacy Officer
North Florida Medical Centers, Inc.
8502986009 | 1/10/2018 9:24 AM |
| Contacts | Authorizing Official | Update | | Wiggins, Tori
CFO
8502986040 | Wiggins, Tori
CFO
North Florida Medical Centers, Inc.
8502986040 | 1/8/2018 3:56 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Lunn, Lane
Compliance Officer
North Florida Medical Centers,Inc
8502986007 | Lunn, Lane
Chief Executive Officer
North Florida Medical Centers,Inc
8502986001 | 1/8/2018 3:32 PM |
| Contacts | Primary Contact | Update | | Lunn, Lane
Compliance Officer
8502986007 | Lunn, Lane
Compliance Officer
North Florida Medical Centers,Inc
8502986007 | 1/8/2018 3:27 PM |
| Contacts | Authorizing Official | Insert | | | Wiggins, Tori
CFO
8502986040 | 7/20/2017 10:44 AM |
| Contacts | Primary Contact | Insert | | | Lunn, Lane
Compliance Officer
8502986007 | 2/13/2017 11:50 AM |
| Addresses | Main Address | Insert | | |
710 W Main St
Mayo, FL 32066-4127 | 2/13/2017 11:50 AM |
| Details | Last Recertification Date | Update | | 2/16/2016 12:00:00 AM | 2/13/2017 12:00:00 AM | 2/13/2017 11:50 AM |
| Details | Last Recertification Date | Update | | 3/3/2015 12:00:00 AM | 2/16/2016 12:00:00 AM | 3/1/2016 9:50 AM |
| Details | Last Recertification Date | Update | | 3/16/2014 12:00:00 AM | 3/3/2015 12:00:00 AM | 3/3/2015 10:02 AM |
| Addresses | Billing Address | Insert | | | North Florida Medical Centers, Inc.
2804 Remington Green Circle
Tallahassee, FL 32308-8707 | 3/16/2014 2:30 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/16/2014 12:00:00 AM | 3/16/2014 2:30 PM |
| Details | Entity Name | Update | | North Florida Medical Centers, Inc. | NORTH FLORIDA MEDICAL CENTERS, INC. | 3/16/2014 2:30 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/20/2013 10:27 AM |
| Details | Entity Subname | Update | | MAYO Medical Center | River Valley Medical Center | 12/13/2012 4:00 PM |
| Details | Entity Subname | Update | | MAYO HEALTH SERVICES | MAYO Medical Center | 1/24/2012 1:35 PM |
| Details | Entity Name | Update | | MAYO MEDICAL CENTER | North Florida Medical Centers, Inc. | 1/24/2012 8:20 AM |
| Details | Comments Public | Insert | | | 1/24/12 - Changed AO and Contact name from DON PORTERFIELD.
1/12/12-Changed entity name to Mayo Medical Center from North Florida Medical Centers, Inc.
11/18/11 - Change main address from 144 SW VIRGINIA CIRCLE abd billing address from 535 John Knox road. 10/30/08 ADDED BILL TO
| 1/24/2012 8:20 AM |
| Details | Entity Name | Update | | NORTH FLORIDA MEDICAL CENTERS, INC. | MAYO MEDICAL CENTER | 1/12/2012 9:56 AM |
| Details | Comments Public | Insert | | | 11/18/11 - Change main address from 144 SW VIRGINIA CIRCLE abd billing address from 535 John Knox road. 10/30/08 ADDED BILL TO
1/12/12-Changed entity name to Mayo Medical Center from North Florida Medical Centers, Inc. | 1/12/2012 9:56 AM |
| Details | Comments Public | Insert | | | 11/18/11 - Change main address from 144 SW VIRGINIA CIRCLE abd billing address from 535 John Knox road. 10/30/08 ADDED BILL TO | 11/18/2011 3:25 PM |
| Details | Last Recertification Date | Insert | | | | 1/12/2010 4:27 PM |
| Details | Grant Number | Insert | | | H80CS00693 | 1/12/2010 4:27 PM |
| Details | 340B ID | Insert | | | CH04038E | 1/12/2010 4:27 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/12/2010 4:27 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/12/2010 4:27 PM |
| Details | Medicare Provider Number | Insert | | | | 1/12/2010 4:27 PM |
| Details | Entity Name | Insert | | | NORTH FLORIDA MEDICAL CENTERS, INC. | 1/12/2010 4:27 PM |
| Details | Program Code | Insert | | | CH | 1/12/2010 4:27 PM |
| Details | Entity Subname | Insert | | | MAYO HEALTH SERVICES | 1/12/2010 4:27 PM |
| Dates | Participating Approval Date | Insert | | | 2/25/2005 12:00:00 AM | 1/12/2010 4:27 PM |
| Details | State | Insert | | | Active | 1/12/2010 4:27 PM |
| Dates | Registration Date | Insert | | | 7/1/2000 12:00:00 AM | 1/12/2010 4:27 PM |
| Dates | Signed By Date | Insert | | | | 1/12/2010 4:27 PM |
| Dates | Start Date | Insert | | | 7/1/2000 12:00:00 AM | 1/12/2010 4:27 PM |
| Terminations | Termination Comments | Insert | | | | 1/12/2010 4:27 PM |
| Terminations | Termination Date | Insert | | | | 1/12/2010 4:27 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/12/2010 4:27 PM |
| Terminations | Termination Reason | Insert | | | | 1/12/2010 4:27 PM |
| Details | Comments Public | Insert | | | 10/30/08 ADDED BILL TO | 1/12/2010 4:27 PM |