Provider Demographics
NPI:1245217520
Name:FAIRVIEW HEALTH SERVICES
Entity Type:Organization
Organization Name:FAIRVIEW HEALTH SERVICES
Other - Org Name:FAIRVIEW RIDGES HOSPITAL
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:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0147
Mailing Address - Country:US
Mailing Address - Phone:612-672-6724
Mailing Address - Fax:
Practice Address - Street 1:201 E NICOLLET BLVD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5714
Practice Address - Country:US
Practice Address - Phone:952-892-2000
Practice Address - Fax:952-892-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZP0105X
MN00107282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5003723OtherMEDICA
MN5000002OtherMEDICA
MN209550500Medicaid
MN18OtherHEALTHPARTNERS
MN1913201OtherMHP
MN300067OtherUCARE
MN1045HPAOtherBCBS
MN4D295FAOtherBCBS
MN76897OtherPREFERREDONE
MN140047OtherUCARE
MN27581OtherHEALTHPARTNERS
MN4D295FAOtherBCBS
MN5003723OtherMEDICA
MN76897OtherPREFERREDONE
MN140047OtherUCARE