Provider Demographics
NPI:1528439130
Name:MAYO HEALTH SYSTEMS, INC
Entity type:Organization
Organization Name:MAYO HEALTH SYSTEMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:SESSION
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-208-0133
Mailing Address - Street 1:PO BOX 3408
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78691-3408
Mailing Address - Country:US
Mailing Address - Phone:225-266-5036
Mailing Address - Fax:555-672-3488
Practice Address - Street 1:4336 NORTH BLVD STE 104
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3920
Practice Address - Country:US
Practice Address - Phone:225-208-0133
Practice Address - Fax:855-567-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1576565Medicaid