Provider Demographics
NPI:1770580664
Name:CITY OF FAIRFAX
Entity type:Organization
Organization Name:CITY OF FAIRFAX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-426-7255
Mailing Address - Street 1:112 SE 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:MN
Mailing Address - Zip Code:55332-0911
Mailing Address - Country:US
Mailing Address - Phone:507-426-7255
Mailing Address - Fax:
Practice Address - Street 1:112 1ST STREET SE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:MN
Practice Address - Zip Code:55332-0911
Practice Address - Country:US
Practice Address - Phone:507-426-7255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1898341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN030701148Medicaid
MN47127FAOtherBLUE CROSS BLUE SHIELD
MN030701148Medicaid
MN599000241Medicare ID - Type Unspecified