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General NPI Number Information
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NPI Number | 1730068032
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Entity Type | Organization
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Legal Business Name | FAIRVIEW MAPLE GROVE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 14500 99TH AVE N STE 500
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4742
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Country | US
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Telephone | 855-324-7843
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55104-3727
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SYSTEM DIRECTOR
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Name | MAUREEN RING
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Credential |
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Telephone | 612-672-6740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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