=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235192006
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAIRVIEW HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2006
-----------------------------------------------------
Last Update Date | 05/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14101 FAIRVIEW DRIVE STE 300
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55337-2537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-892-2043
-----------------------------------------------------
Fax | 952-892-2139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 UNIVERSITY AVE W
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55104-3727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-672-6740
-----------------------------------------------------
Fax | 612-884-3592
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SYSTEM EXECUTIVE HME AND O&P
-----------------------------------------------------
Name | JILL MARIE MCCARTNEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-632-9835
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------