Healthcare Provider Details

I. General information

NPI: 1487885653
Provider Name (Legal Business Name): FAIRMONT ORTHOPEDICS & SPORTS MEDICINE P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 6TH ST
ARMSTRONG IA
50514-7432
US

IV. Provider business mailing address

717 S STATE ST SUITE 900
FAIRMONT MN
56031-4469
US

V. Phone/Fax

Practice location:
  • Phone: 507-238-4949
  • Fax: 507-238-3365
Mailing address:
  • Phone: 507-238-4949
  • Fax: 507-238-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: LINDA LYNN THOMPSON
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 307-277-9668