Provider Demographics
NPI:1922085299
Name:FAIRVIEW HEALTH SERVICES
Entity Type:Organization
Organization Name:FAIRVIEW HEALTH SERVICES
Other - Org Name:FAIRVIEW NORTHLAND REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, NETWORK RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:RING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-672-6740
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0147
Mailing Address - Country:US
Mailing Address - Phone:612-672-6724
Mailing Address - Fax:
Practice Address - Street 1:911 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-2172
Practice Address - Country:US
Practice Address - Phone:763-389-1313
Practice Address - Fax:763-389-6306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2023-11-30
Deactivation Date:2023-10-04
Deactivation Code:
Reactivation Date:2023-10-19
Provider Licenses
StateLicense IDTaxonomies
207ZP0105X, 367500000X
MN00408282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN20103813OtherMHP
MN24560FAOtherBCBS
MN1006066OtherPREFERREDONE
MN9840014OtherMEDICA
MN5002OtherPREFERREDONE
MN1814HFAOtherBCBS
MN5002017OtherMEDICA
MN8866OtherHEALTHPARTNERS
MN710047700Medicaid
MN76895OtherPREFERREDONE
MN980226003OtherMHP
MN27581OtherHEALTHPARTNERS
MN3943740OtherMEDICA
MN140046OtherUCARE
MN15F16VAOtherBCBS
MN710047700Medicaid
MN240141Medicare Oscar/Certification
MNC06076Medicare PIN