1457397150 NPI number — FAIRVIEW EXPRESS CARE

Table of content: (NPI 1457397150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457397150 NPI number — FAIRVIEW EXPRESS CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRVIEW EXPRESS CARE
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:
M HEALTH FAIRVIEW PAIN CLINIC - MINNEAPOLIS
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:
1457397150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9372
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:
55440-9372
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:
606 24TH AVE S
Provider Second Line Business Practice Location Address:
STE 600
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55454-5020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-273-5400
Provider Business Practice Location Address Fax Number:
612-273-9945
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCOY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
VP REVENUE MANAGEMENT
Authorized Official Telephone Number:
612-672-6594

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 173032 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 104855 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 648467100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 72B50FA . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 19122 . This is a "MHP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 96062 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 9805117 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 112516 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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