| Fairview Clinics-prior Lake | |
|
4151 Willowwood St Se Prior Lake MN 55372-4304 | |
| (952) 226-2600 | |
| (952) 226-2601 |
| Full Name | Fairview Clinics-prior Lake |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 4151 Willowwood St Se, Prior Lake, 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-prior Lake Po Box 9372 Minneapolis MN 55440-9372 Ph: (612) 672-6724 | Fairview Clinics-prior Lake 4151 Willowwood St Se Prior Lake MN 55372-4304 Ph: (952) 226-2600 |
| NPI Number | 1568654341 |
|---|---|
| Provider Enumeration Date | 08/15/2007 |
| Last Update Date | 10/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568654341 | NPI | - | NPPES |
| 752820514 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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