Provider Demographics
NPI:1790977486
Name:FAIRVIEW CLINICS
Entity Type:Organization
Organization Name:FAIRVIEW CLINICS
Other - Org Name:FAIRVIEW CLINICS-BASS LAKE
Other - Org Type:Doing Business As
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 1:6320 WEDGEWOOD RD N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-3647
Practice Address - Country:US
Practice Address - Phone:763-268-0400
Practice Address - Fax:763-268-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN156927000Medicaid
MNC01379Medicare PIN
MN156927000Medicaid
MNCC4080Medicare PIN