FAIRVIEW EXPRESS CARE

Provider Demographics

• NPI: 1407834302
• Name: FAIRVIEW EXPRESS CARE
• Entity Type: Organization
• Organization Name: FAIRVIEW EXPRESS CARE
• Other - Org Name: INSTITUTE FOR ATHLETIC MEDICINE
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: VP REVENUE MANAGEMENT
• Authorized Official - First Name: ROBERT
• Authorized Official - Middle Name: ANDREW
• Authorized Official - Last Name: MCCOY
• Authorized Official - Phone: 612-672-6594
• Mailing Address - Street 1: PO BOX 9372
• Mailing Address - City: MINNEAPOLIS
• Mailing Address - State: MN
• Mailing Address - Zip Code: 55440-9372
• Mailing Address - Country: US
• Mailing Address - Phone: 612-672-6724
• Practice Address - Street 1: 2600 39TH AVE NE
• Practice Address - Street 2: STE 220
• Practice Address - City: MINNEAPOLIS
• Practice Address - State: MN
• Practice Address - Zip Code: 55421-4379
• Practice Address - Country: US
• Practice Address - Phone: 612-789-0417
• Practice Address - Fax: 612-789-0522
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-01-03
• Last Update Date: 2023-01-16

Provider Licenses

State	License ID	Taxonomies
MN		261QP2000X
		261QR0401X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	261QP2000X	Ambulatory Health Care Facilities	Clinic/Center	Physical Therapy
No	261QR0401X	Ambulatory Health Care Facilities	Clinic/Center	Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MN	240725600	Medicaid
MN	240725612	Medicaid
MN	240725605	Medicaid
MN	240725614	Medicaid
MN	240725616	Medicaid
MN	240725601	Medicaid
MN	240725615	Medicaid
MN	240725619	Medicaid
MN	240725627	Medicaid
MN	240725603	Medicaid
MN	240725617	Medicaid
MN	240725618	Medicaid
MN	240725623	Medicaid
MN	240725626	Medicaid
MN	240725602	Medicaid
MN	240725609	Medicaid
MN	240725611	Medicaid
MN	240725621	Medicaid
MN	240725625	Medicaid
MN	207168200	Medicaid
MN	240725607	Medicaid
MN	240725608	Medicaid
MN	240725604	Medicaid
MN	240725606	Medicaid
MN	240725610	Medicaid
MN	116422800	Medicaid
MN	240725613	Medicaid
MN	240725618	Medicaid
MN	240725621	Medicaid