MEDICARE: FAIRVIEW SPECIALTY SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service	20213149	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912066218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRVIEW SPECIALTY 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	:	1700 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-3727
Country	:	US
Telephone Number	:	763-525-9919
Fax Number	:	763-525-9918

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	06/02/2026

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Directions to “FAIRVIEW SPECIALTY SERVICES ” Practice Location

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