Provider Demographics
NPI:1457397150
Name:FAIRVIEW EXPRESS CARE
Entity Type:Organization
Organization Name:FAIRVIEW EXPRESS CARE
Other - Org Name:M HEALTH FAIRVIEW PAIN CLINIC - MINNEAPOLIS
Other - Org Type:Doing Business As
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 1:606 24TH AVE S
Practice Address - Street 2:STE 600
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-5020
Practice Address - Country:US
Practice Address - Phone:612-273-5400
Practice Address - Fax:612-273-9945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN173032OtherUCARE
MN104855OtherHEALTHPARTNERS
MN648467100Medicaid
MN72B50FAOtherBCBS
MN19122OtherMHP
MN96062OtherPREFERREDONE
MN9805117OtherMEDICA
MN112516OtherHEALTHPARTNERS
MN648467100Medicaid
MNC04126Medicare PIN
MN104855OtherHEALTHPARTNERS