Provider Demographics
NPI:1346422318
Name:FAIRVIEW CLINICS
Entity Type:Organization
Organization Name:FAIRVIEW CLINICS
Other - Org Name:M HEALTH FAIRVIEW CLINIC - COLUMBIA HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REVENUE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-672-6594
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 1:4000 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-2968
Practice Address - Country:US
Practice Address - Phone:763-572-5700
Practice Address - Fax:763-782-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN104020OtherUCARE CLINIC NUMBER
MN607482000Medicaid
MN221547OtherHEALTH PARTNERS
MN98-01408OtherMEDICA CLINIC NUMBER
MNFP917OtherPREFERRED ONE
MN02991COOtherBCBS OF MN
MN98-01408OtherMEDICA CLINIC NUMBER
MN02991COOtherBCBS OF MN