Provider Demographics
NPI:1881141349
Name:FAIRVIEW EXPRESS CARE
Entity type:Organization
Organization Name:FAIRVIEW EXPRESS CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP REVENUE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-672-6594
Mailing Address - Street 1:3305 CENTRAL PARK VILLAGE DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-7707
Mailing Address - Country:US
Mailing Address - Phone:651-406-8868
Mailing Address - Fax:612-273-6057
Practice Address - Street 1:3305 CENTRAL PARK VILLAGE DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-7707
Practice Address - Country:US
Practice Address - Phone:651-406-8868
Practice Address - Fax:612-273-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty