Healthcare Provider Details

I. General information

NPI: 1245461334
Provider Name (Legal Business Name): FAIRMONT ORTHOPEDICS & SPORTS MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S STATE ST STE 900
FAIRMONT MN
56031-4400
US

IV. Provider business mailing address

717 SO STATE ST SUITE 900
FAIRMONT MN
56031
US

V. Phone/Fax

Practice location:
  • Phone: 507-238-4949
  • Fax:
Mailing address:
  • Phone: 507-825-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA THOMPSON
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 507-238-4949