Basic Information
| Provider Information | |||||||||
| NPI: | 1811550155 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAIRVIEW CLINICS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | M HEALTH FAIRVIEW CLINIC RIVER FALLS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 STINSON BLVD | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554132613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126722258 | ||||||||
| FaxNumber: | 6126726041 | ||||||||
| Practice Location | |||||||||
| Address1: | 319 SOUTH MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | RIVER FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540221571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154256071 | ||||||||
| FaxNumber: | 7154257075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2019 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCCOY | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | ANDREW | ||||||||
| AuthorizedOfficialTitleorPosition: | VP REVENUE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 6126726594 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.