Provider Demographics
NPI:1467116186
Name:FAIRVIEW EXPRESS CARE
Entity Type:Organization
Organization Name:FAIRVIEW EXPRESS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REV MAN
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 1:6545 FRANCE AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2131
Mailing Address - Country:US
Mailing Address - Phone:952-836-3695
Mailing Address - Fax:
Practice Address - Street 1:6545 FRANCE AVE S STE 450
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2122
Practice Address - Country:US
Practice Address - Phone:952-836-3695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty