MEDICARE: FAIRVIEW HEALTH SERVICES

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician
2	282N00000X	General Acute Care Hospital	00107	MN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	140047	OTHER	MN	UCARE
2	300067	OTHER	MN	UCARE
3	4D295FA	OTHER	MN	BCBS
4	5000002	OTHER	MN	MEDICA
5	76897	OTHER	MN	PREFERREDONE
6	18	OTHER	MN	HEALTHPARTNERS
7	1913201	OTHER	MN	MHP
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	27581	OTHER	MN	HEALTHPARTNERS
10	1045HPA	OTHER	MN	BCBS
11	5003723	OTHER	MN	MEDICA
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1245217520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRVIEW HEALTH SERVICES

Provider Business Mailing Address
First Line	:	1700 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-3727
Country	:	US
Telephone Number	:	612-672-6740
Fax Number	:	612-884-3592

Provider Business Practice Location Address
First Line	:	201 E NICOLLET BLVD
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-5714
Country	:	US
Telephone Number	:	952-892-2000
Fax Number	:	952-892-2107

Authorized Official
Title or Position	:	SYS DIR GOVT REIMB & NETWK REL
Name	:	MAUREEN VERONICA-REGER RING
Credential	:
Telephone Number	:	612-672-6740

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	06/26/2026