1538213566 NPI number — GROUP HEALTH PLAN, INC

Table of content: WILLIAM GIORDANO LCSW (NPI 1508958554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538213566 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:
1538213566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8100 34TH AVE S
Provider Second Line Business Mailing Address:
21113A
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55425-1672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-883-5151
Provider Business Mailing Address Fax Number:
952-883-5160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2251 CONNECTICUT AVE
Provider Second Line Business Practice Location Address:
HEALTHPARTNERS CENTRAL MN CLINIC - DENTAL
Provider Business Practice Location Address City Name:
SARTELL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56337-4772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-253-5824
Provider Business Practice Location Address Fax Number:
320-203-2076
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GESKO
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DENTAL DIRECTOR AND SR. VICE PRESID
Authorized Official Telephone Number:
952-883-7577

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7477163-00 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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