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CAH521315-07 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 - Physical Medicine and Rehabilitation
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521315-07
Medicare Provider Number
521315
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
9/15/2020
Participating Start Date
10/1/2020
Participating Approval Date
9/22/2020
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 St
Ste H
Rice Lake, WI 54868
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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