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General NPI Number Information
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NPI Number | 1134173644
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Entity Type | Organization
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Legal Business Name | FAIRMONT ORTHOPEDICS & SPORTS MEDICINE, PA
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 717 S STATE ST SUITE 900
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City | FAIRMONT
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State | MN
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Zip | 56031-4469
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Country | US
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Telephone | 507-238-4949
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Fax | 507-238-3377
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Provider Business Mailing Address
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Address Line | 717 S STATE ST STE 900
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City | FAIRMONT
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State | MN
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Zip | 56031-4400
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Country | US
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Telephone | 507-238-4949
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Fax | 507-238-3365
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER ADMIN AP
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Name | LINDA LYNN THOMPSON
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Credential |
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Telephone | 507-238-4949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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