Provider Demographics
NPI:1770663031
Name:FAIRVIEW HEALTH SERVICES
Entity Type:Organization
Organization Name:FAIRVIEW HEALTH SERVICES
Other - Org Name:FAIRVIEW SOUTHDALE HOSPITAL - PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR NETWORK RELATIONS AO
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-672-6740
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 1:6401 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2104
Practice Address - Country:US
Practice Address - Phone:952-924-5000
Practice Address - Fax:952-924-5382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN331263OtherUCARE
MN5023736OtherMEDICA
MN9866184OtherMEDICA
MN42961OtherPREFERREDONE
MN73771OtherHEALTHPARTNERS
MN9807338OtherMEDICA
MN300075OtherUCARE
MN128125000Medicaid
MN17764TEOtherBCBS
MN60328099OtherMHP
MN9000019122OtherMHP
MN9000019122OtherMHP
MN300075OtherUCARE
MNC01758Medicare PIN