1700235587 NPI number — FAIRVIEW EXPRESS CARE

Table of content: DAWN RENEE SEIGNEUR PT (NPI 1164888012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700235587 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 PEDIATRIC THERAPY - WOODBURY
Provider Other Organization Name Type Code:
5
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:
1700235587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2450 RIVERSIDE AVE
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:
55454-1450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-273-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9680 TAMARACK RD
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55125-2617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-273-1172
Provider Business Practice Location Address Fax Number:
612-273-8490
Provider Enumeration Date:
06/13/2016

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: 2081P0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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