Healthcare Provider Details

I. General information

NPI: 1164959938
Provider Name (Legal Business Name): GROUP HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8455 FLYING CLOUD DR
EDEN PRAIRIE MN
55344-3974
US

IV. Provider business mailing address

8170 33RD AVE S MAILSTOP 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-883-9040
  • Fax: 952-941-8857
Mailing address:
  • Phone: 952-883-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11643
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number11843
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12166
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number10651
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number12628
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12105
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12245
License Number StateMN
# 8
Primary TaxonomyN
Taxonomy Code125Q00000X
TaxonomyOral Medicine Dentistry
License Number13340
License Number StateMN

VIII. Authorized Official

Name: ALITA RISINGER
Title or Position: SR VICE PRESIDENT, CFO
Credential:
Phone: 952-883-5401