| Organization Name: | FAIRMONT ORTHOPEDICS & SPORTS MEDICINE, P.A. |
| NPI Number: | 1114374469 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | COREY T WELCHLIN (OWNER) |
| Mailing Address: | 717 S State St Ste 1000 Fairmont |
| State: | MN US |
| Postal Code: | 560314469 |
| Phone Number: | 5072353939 |
| Fax Number: | |
| NPI Enumeration Date: | 05/17/2016 |
| NPI Last Update Date: | 05/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |