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CAH521315-06 Mayo Clinic Health System Northland (Active)
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Main Details
Name
Mayo Clinic Health System Northland
Subdivision Name
MCHS-NORTHLAND IN RICE LAKE - Gastroenterology & Hepatology
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521315-06
Medicare Provider Number
521315
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/6/2023
Participating Start Date
1/1/2024
Participating Approval Date
10/11/2023
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Mayo Clinic
Michele Eberle, Vice Chair-Administration NWWI
(715) 568-6113
Primary Contact
Mayo Clinic Health System
Matt Lemin, Program Manager
(507) 293-3853
Addresses
Street Address
331 S MAIN STREET
SUITE H
RICE LAKE, WI 54868-2239
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (04/1/2018), Termination effective date: (07/1/2022), Reinstatement effective date: (1/1/2024)
10/11/2023
April 2025
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