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General NPI Number Information
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NPI Number | 1124210760
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Entity Type | Organization
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Legal Business Name | FAIRVIEW CLINICS
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 14040 NORTHDALE BLVD STE 10
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City | ROGERS
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State | MN
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Zip | 55374-9612
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Country | US
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Telephone | 763-488-4100
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Fax | 763-488-4105
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Provider Business Mailing Address
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Address Line | 1700 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55104-3727
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Country | US
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Telephone | 612-672-6740
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Fax | 612-884-3592
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Authorized Official
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Title or Position | SYS DIR GOVT REIMB & NETWK REL
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Name | MAUREEN V RING
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Credential |
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Telephone | 612-672-6740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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