{
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "FAIRVIEW EXPRESS CARE",
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 9372",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MINNEAPOLIS",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55440-9372",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-672-6724",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "20 LAKE ST N",
"SecondLinePracticeLocationAddress": "STE 210",
"PracticeLocationAddressCityName": "FOREST LAKE",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55025-2511",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "612-672-6999",
"PracticeLocationAddressFaxNumber": "651-464-4847",
"EnumerationDate": "06/30/2009",
"LastUpdateDate": "10/26/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCCOY",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "ANDREW",
"AuthorizedOfficialTitle": "VP REVENUE MANAGEMENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "612-672-6594",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}