1922085299 NPI number — FAIRVIEW HEALTH SERVICES

Table of content: (NPI 1922085299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922085299 NPI number — FAIRVIEW HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRVIEW HEALTH SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAIRVIEW NORTHLAND REGIONAL HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922085299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/04/2023
NPI Reactivation Date:
10/19/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55440-0147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-672-6724
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
911 NORTHLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55371-2172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-389-1313
Provider Business Practice Location Address Fax Number:
763-389-6306
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RING
Authorized Official First Name:
MAUREEN
Authorized Official Middle Name:
VERONICA
Authorized Official Title or Position:
DIRECTOR, NETWORK RELATIONS
Authorized Official Telephone Number:
612-672-6740

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 00408 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20103813 . This is a "MHP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 24560FA . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1006066 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 9840014 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5002 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1814HFA . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5002017 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8866 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 710047700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 76895 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 980226003 . This is a "MHP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 27581 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3943740 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 140046 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 15F16VA . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 102443000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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