Provider Demographics
NPI:1770547796
Name:FAIRVIEW HEALTH SERVICES
Entity type:Organization
Organization Name:FAIRVIEW HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SYSTEM EXECUTIVE HME O&P
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCCARTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-632-9835
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:612-672-7601
Mailing Address - Fax:612-884-3592
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:STE 450B
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2131
Practice Address - Country:US
Practice Address - Phone:952-929-7717
Practice Address - Fax:952-929-4535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2025-05-13
Deactivation Date:2023-10-04
Deactivation Code:
Reactivation Date:2024-02-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN757615300Medicaid
MN110289OtherUCARE
MN8200173OtherMEDICA
MN8253OtherHEALTHPARTNERS
MN67Q55FAOtherBCBS
MN8200173OtherMEDICA
MN757615300Medicaid