1215048913 NPI number — GROUP HEALTH PLAN INC.

Table of content: (NPI 1215048913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215048913 NPI number — GROUP HEALTH PLAN INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GROUP HEALTH PLAN INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215048913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8170 33RD AVE S
Provider Second Line Business Mailing Address:
MAILSTOP 21110Q
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55440-1309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-883-7123
Provider Business Mailing Address Fax Number:
952-853-8727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9700 W 76TH ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
EDEN PRAIRIE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-829-3390
Provider Business Practice Location Address Fax Number:
952-829-3380
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BJORKMAN
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
952-883-7469

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  8600490 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 24D0668589 . This is a "CLIA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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