Provider Demographics
NPI:1720096654
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 1:14101 FAIRVIEW DRIVE
Practice Address - Street 2:SUITE 270
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2523
Practice Address - Country:US
Practice Address - Phone:952-460-4940
Practice Address - Fax:952-460-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN603407000Medicaid
MN77B78FAOtherBCBS
MN182494OtherUCARE
MN8200708OtherMEDICA
MN8200708OtherMEDICA
MN0438370045Medicare NSC