Provider Demographics
NPI:1659509552
Name:FAIRVIEW EXPRESS CARE
Entity type:Organization
Organization Name:FAIRVIEW EXPRESS CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SYS DIR GOVT REIMB & NETWK REL
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:RING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-672-6740
Mailing Address - Street 1:1700 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3727
Mailing Address - Country:US
Mailing Address - Phone:612-672-6740
Mailing Address - Fax:612-884-3592
Practice Address - Street 1:3400 W 66TH ST
Practice Address - Street 2:STE 400
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2134
Practice Address - Country:US
Practice Address - Phone:612-672-6999
Practice Address - Fax:952-914-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC05530Medicare PIN