| Fairview Clinics-bass Lake | |
|
6320 Wedgewood Rd N Maple Grove MN 55311-3647 | |
| (763) 268-0400 | |
| (763) 268-0405 |
| Full Name | Fairview Clinics-bass Lake |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 6320 Wedgewood Rd N, Maple Grove, Minnesota |
| Authorized Official Name and Position | Maureen Ring (DIRECTOR NETWORK RELATIONS AO) |
| Authorized Official Contact | 6126726740 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairview Clinics-bass Lake Po Box 9372 Minneapolis MN 55440-9372 Ph: (612) 672-6724 | Fairview Clinics-bass Lake 6320 Wedgewood Rd N Maple Grove MN 55311-3647 Ph: (763) 268-0400 |
| NPI Number | 1790977486 |
|---|---|
| Provider Enumeration Date | 08/16/2007 |
| Last Update Date | 10/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790977486 | NPI | - | NPPES |
| 156927000 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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