FAIRVIEW MEDICATION THERAPY MANAGEMENT -MAPLE GROVE (NPI# 1063615979) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063615979 |
| Entity Type | Organization |
| Organization Name | FAIRVIEW MEDICATION THERAPY MANAGEMENT -MAPLE GROVE |
| Practice Address |
14500 99th Ave N Suite 1c001 Maple Grove MN 55369 |
| Mailing Address |
Po Box 1450 Nw5823 Minneapolis MN 55485 |
| Practice Telephone | 7638981810 |
| Mailing Telephone | 7638981810 |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | STEVEN KIMMEL (CONTRACTS MANAGER) |
| Authorized Official Telephone | 6126725302 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | APPLIED | MN | Suppliers |
| Street Address |
14500 99TH AVE N SUITE 1C001 |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265748230 | Maple Grove Hospital Corporation | Non-Pharmacy Dispensing Site | 9875 Hospital Dr, Maple Grove, MN 55369-4648 | 2010-08-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518528397 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | Fairview Lakeville Clinic Mtm, 18580 Joplin Ave, Lakeville, MN 55044 | 2019-06-24 |
| 1851856504 | Tareen Dermatology, Pa | Non-Pharmacy Dispensing Site | 2945 Hazelwood St Ste 230, Maplewood, MN 55109-1241 | 2019-02-07 |
| 1417450651 | Cerner Health Connections, Inc | Non-Pharmacy Dispensing Site | 4001 Lexington Ave N Ste C2-435, Arden Hills, MN 55126-2934 | 2018-03-14 |
| 1316461593 | Fairview Pharmacy Service LLC | Non-Pharmacy Dispensing Site | 7250 France Ave S Ste 410, Edina, MN 55435-4314 | 2017-07-31 |
| 1346653052 | Advanced Spine and Pain Clinics of Mn, LLC | Non-Pharmacy Dispensing Site | 308 Brighton Ave, Suite D, Buffalo, MN 55313-2303 | 2014-06-10 |
| 1407296148 | Group Health Plan Inc | Non-Pharmacy Dispensing Site | 1833 2nd Ave, Anoka, MN 55303-2432 | 2013-06-26 |
| 1295178135 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 6440 Nicollet Ave South, Richfield, MN 55423-1613 | 2013-04-10 |
| 1992148845 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 2450 Riverside Ave South, Minneapolis, MN 55454-1400 | 2013-04-10 |
| 1083984876 | Mayo Clinic Health System-southeast Minnesota Region | Non-Pharmacy Dispensing Site | 32021 County 24 Boulevard, Cannon Falls, MN 55009-1824 | 2012-01-10 |
| 1255623765 | Mankato Clinic, Ltd | Non-Pharmacy Dispensing Site | 305 Main St Ne, Mapleton, MN 56065 | 2011-05-03 |
| Find all providers with the same taxonomy | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
Please comment or provide details below to improve the information on FAIRVIEW MEDICATION THERAPY MANAGEMENT -MAPLE GROVE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.