1396708038 NPI number — FAIRVIEW HEALTH SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396708038 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:
Provider Other Organization Name Type Code:
6
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:
1396708038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10961 CLUB WEST PKWY NE
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
BLAINE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55449-5866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-852-6401
Provider Business Practice Location Address Fax Number:
763-852-6402
Provider Enumeration Date:
04/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCARTNEY
Authorized Official First Name:
JILL
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
SYSTEM EXECUTIVE 0&P
Authorized Official Telephone Number:
651-632-9835

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 122572 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8253 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 67Q55FA . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 290458600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8200176 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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