NPI Code Details Logo

NPI 1417037896

NPI 1417037896 : FAIRVIEW HEALTH SERVICES : WYOMING, MN

=====================================================
General NPI Number Information
=====================================================
    NPI Number           |    1417037896
-----------------------------------------------------
    Entity Type          |    Organization 
-----------------------------------------------------
    Legal Business Name  |    FAIRVIEW HEALTH SERVICES 
-----------------------------------------------------

=====================================================
Dates
=====================================================
    Enumeration Date     |    10/17/2006
-----------------------------------------------------
    Last Update Date     |    02/24/2025
-----------------------------------------------------

=====================================================
Provider Practice Location Address
=====================================================
    Address Line         |    5200 FAIRVIEW BLVD 
-----------------------------------------------------
    City                 |    WYOMING
-----------------------------------------------------
    State                |    MN
-----------------------------------------------------
    Zip                  |    55092-8013
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    651-982-7000
-----------------------------------------------------
    Fax                  |    651-982-7110
-----------------------------------------------------

=====================================================
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    |    SYS DIR GOVT REIMB & NETWK REL
-----------------------------------------------------
    Name                 |     MAUREEN V RING 
-----------------------------------------------------
    Credential           |    
-----------------------------------------------------
    Telephone            |    612-672-6740
-----------------------------------------------------

=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
    Taxonomy Code        |    207P00000X
-----------------------------------------------------
    Taxonomy Name        |    Emergency Medicine Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
    Taxonomy Code        |    207R00000X
-----------------------------------------------------
    Taxonomy Name        |    Internal Medicine Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
    Taxonomy Code        |    207V00000X
-----------------------------------------------------
    Taxonomy Name        |    Obstetrics & Gynecology Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
    Taxonomy Code        |    208M00000X
-----------------------------------------------------
    Taxonomy Name        |    Hospitalist Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
    Taxonomy Code        |    363L00000X
-----------------------------------------------------
    Taxonomy Name        |    Nurse Practitioner
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
    Taxonomy Code        |    207Q00000X
-----------------------------------------------------
    Taxonomy Name        |    Family Medicine Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------



                        

Copyright © 2007-2026 Data Labs Health. All rights reserved.