Provider Demographics
NPI:1336331297
Name:FAIRVIEW CLINICS
Entity Type:Organization
Organization Name:FAIRVIEW CLINICS
Other - Org Name:FAIRVIEW CLINICS-EDEN PRAIRIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:FROMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-672-4976
Mailing Address - Street 1:PO BOX 9372
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-9372
Mailing Address - Country:US
Mailing Address - Phone:612-672-6724
Mailing Address - Fax:
Practice Address - Street 1:830 PRAIRIE CENTER DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7301
Practice Address - Country:US
Practice Address - Phone:952-826-6500
Practice Address - Fax:952-826-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN752820517Medicaid
MNC01379Medicare PIN
MN752820517Medicaid
MNC01566Medicare PIN