=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396708038
-----------------------------------------------------
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 | 10961 CLUB WEST PKWY NE STE 220
-----------------------------------------------------
City | BLAINE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55449-5866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-852-6401
-----------------------------------------------------
Fax | 763-852-6402
-----------------------------------------------------
=====================================================
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 0&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 |
-----------------------------------------------------