Healthcare Provider Details

I. General information

NPI: 1043402688
Provider Name (Legal Business Name): FAIRVIEW CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 CENTRAL PARK VILLAGE DR SUITE 200
EAGAN MN
55121-7707
US

IV. Provider business mailing address

1700 UNIVERSITY AVE W
SAINT PAUL MN
55104-3727
US

V. Phone/Fax

Practice location:
  • Phone: 651-406-8860
  • Fax: 651-688-7864
Mailing address:
  • Phone: 612-672-6740
  • Fax: 612-884-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN V RING
Title or Position: SYS DIR GOVT REIMB & NETWK REL
Credential:
Phone: 612-672-6740