Organization
FAIRVIEW EXPRESS CARE
Active
Other names
Institute for Athletic Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT ANDREW MCCOY (VP REVENUE MANAGEMENT)
(612) 672-6594
Entity
Organization
Contact information
Practice address
2600 39TH AVE NE, STE 220, MINNEAPOLIS, MN 55421-4379
(612) 789-0417
(612) 789-0522
Mailing address
PO BOX 9372, MINNEAPOLIS, MN 55440-9372
(612) 672-6724
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
MN
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116422800
—
MN
05
—
207168200
—
MN
05
—
240725600
—
MN
05
—
240725601
—
MN
05
—
240725602
—
MN
05
—
240725603
—
MN
05
—
240725604
—
MN
05
—
240725605
—
MN
05
—
240725606
—
MN
05
—
240725607
—
MN
05
—
240725608
—
MN
05
—
240725609
—
MN
05
—
240725610
—
MN
05
—
240725611
—
MN
05
—
240725612
—
MN
05
—
240725613
—
MN
05
—
240725614
—
MN
05
—
240725615
—
MN
05
—
240725616
—
MN
05
—
240725617
—
MN
05
—
240725618
—
MN
05
—
240725619
—
MN
05
—
240725621
—
MN
05
—
240725623
—
MN
05
—
240725625
—
MN
05
—
240725626
—
MN
05
—
240725627
—
MN
Enumeration date
01/03/2006
Last updated
01/16/2023
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