Healthcare Provider Details

I. General information

NPI: 1508873464
Provider Name (Legal Business Name): FAIRVIEW HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 UNIVERSITY AVE W STE 114
SAINT PAUL MN
55114-1839
US

IV. Provider business mailing address

1700 UNIVERSITY AVE W
SAINT PAUL MN
55104-3727
US

V. Phone/Fax

Practice location:
  • Phone: 651-644-5808
  • Fax: 651-644-5926
Mailing address:
  • Phone: 612-672-6740
  • Fax: 651-884-3592

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 HME O&P
Credential:
Phone: 651-632-9835