| Fairview Clinics-rogers | |
|
14040 Northdale Blvd Ste 10 Rogers MN 55374-9612 | |
| (763) 488-4100 | |
| (763) 488-4105 |
| Full Name | Fairview Clinics-rogers |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 14040 Northdale Blvd, Rogers, Minnesota |
| Authorized Official Name and Position | Daniel M Fromm (CFO) |
| Authorized Official Contact | 6126724976 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairview Clinics-rogers Po Box 9372 Minneapolis MN 55440-9372 Ph: (612) 672-6724 | Fairview Clinics-rogers 14040 Northdale Blvd Ste 10 Rogers MN 55374-9612 Ph: (763) 488-4100 |
| NPI Number | 1124210760 |
|---|---|
| Provider Enumeration Date | 08/17/2007 |
| Last Update Date | 10/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124210760 | NPI | - | NPPES |
| 430067100 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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