Robert Fairbanks

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Practice address

1502 Willard Ave # a
Detroit Lakes, MN 56501-4324

Phone

(218) 847-3456

NPI assigned

Oct 22, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664496000000",
    "number": "1972146041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 WILLARD AVE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565014324",
            "telephone_number": "218-847-3456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 WILLARD AVE # A",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565014324",
            "telephone_number": "218-847-3456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1038 Campbell Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit Lakes",
            "state": "MN",
            "postal_code": "565013202",
            "country_code": "US",
            "telephone_number": "218-847-3456",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAIRBANKS",
        "first_name": "ROBERT",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-22",
        "last_updated": "2022-09-30",
        "certification_date": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMPI",
            "identifier": "A598473100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krystal Enger, PA-C
• Michelle R England, MSW
• Cynthia Englehart
• Benjamin B Evenson, CRNA
• Elizabeth Evenson, PSY.D., LP
• Renee Ann Fasteen, MSW, LICSW
• FCSL Detroit Lakes, LLC
• FCSL Detroit Lakes, LLC
• Paige Nicole Feist, APRN,CNP
• Zachary Fennell

• All providers in Detroit Lakes, MN
• Non-emergency Medical Transport (VAN) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.