Healthcare Provider Details

I. General information

NPI: 1669082947
Provider Name (Legal Business Name): GROUP HEALTH PLAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 47TH AVE N
NEW HOPE MN
55428-4512
US

IV. Provider business mailing address

8170 33RD AVE S
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-883-7293
  • Fax: 763-504-4932
Mailing address:
  • Phone: 952-883-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

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