Provider Demographics
NPI:1134280035
Name:FAIRVIEW HEALTH SERVICES
Entity Type:Organization
Organization Name:FAIRVIEW HEALTH SERVICES
Other - Org Name:FAIRVIEW DIAGNOSTIC LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR NETWORK RELATIONS AO
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-672-6740
Mailing Address - Street 1:1700 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3727
Mailing Address - Country:US
Mailing Address - Phone:612-672-6740
Mailing Address - Fax:
Practice Address - Street 1:5200 FAIRVIEW BLVD
Practice Address - Street 2:OUTREACH LAB DEPARTMENT
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-8013
Practice Address - Country:US
Practice Address - Phone:651-982-7220
Practice Address - Fax:651-982-7225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN12115817OtherMHP
MN468S0FAOtherBCBS
MN5025460OtherMEDICA
MN27581OtherHEALTHPARTNERS
MN1006080OtherPREFERREDONE
MN300982OtherUCARE
MN1640HDIOtherBCBS
MN792825400Medicaid
MNC00073Medicare PIN
MN5025460OtherMEDICA
MNCD2641Medicare PIN