Healthcare Provider Details

I. General information

NPI: 1407834302
Provider Name (Legal Business Name): FAIRVIEW EXPRESS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 39TH AVE NE STE 220
MINNEAPOLIS MN
55421-4379
US

IV. Provider business mailing address

PO BOX 9372
MINNEAPOLIS MN
55440-9372
US

V. Phone/Fax

Practice location:
  • Phone: 612-789-0417
  • Fax: 612-789-0522
Mailing address:
  • Phone: 612-672-6724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT ANDREW MCCOY
Title or Position: VP REVENUE MANAGEMENT
Credential:
Phone: 612-672-6594