Healthcare Provider Details

I. General information

NPI: 1396708038
Provider Name (Legal Business Name): FAIRVIEW HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10961 CLUB WEST PKWY NE STE 220
BLAINE MN
55449-5866
US

IV. Provider business mailing address

1700 UNIVERSITY AVE W
SAINT PAUL MN
55104-3727
US

V. Phone/Fax

Practice location:
  • Phone: 763-852-6401
  • Fax: 763-852-6402
Mailing address:
  • Phone: 612-672-6740
  • Fax: 612-884-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JILL MARIE MCCARTNEY
Title or Position: SYSTEM EXECUTIVE 0&P
Credential:
Phone: 651-632-9835