Provider Demographics
NPI:1710293402
Name:FAIRVIEW EXPRESS CARE
Entity Type:Organization
Organization Name:FAIRVIEW EXPRESS CARE
Other - Org Name:M HEALTH FAIRVIEW ORTHOPEDICS EDEN PRAIRIE
Other - Org Type:Other Name
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 1:775 PRAIRIE CENTER DR
Practice Address - Street 2:STE 250
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7334
Practice Address - Country:US
Practice Address - Phone:952-944-5314
Practice Address - Fax:952-944-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC01379Medicare PIN