Healthcare Provider Details

I. General information

NPI: 1710924683
Provider Name (Legal Business Name): GROUP HEALTH PLAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 CHICAGO AVE
MINNEAPOLIS MN
55407-3570
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 952-967-7485
  • Fax: 612-313-0004
Mailing address:
  • Phone: 952-883-7469
  • Fax: 952-883-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA BJORKMAN
Title or Position: DIRECTOR
Credential:
Phone: 952-883-7469