Healthcare Provider Details

I. General information

NPI: 1326559709
Provider Name (Legal Business Name): GROUP HEALTH PLAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 GREELEY ST S
STILLWATER MN
55082-5935
US

IV. Provider business mailing address

PO BOX 1309, MAILSTOP 21110Q
MINNEAPOLIS MN
55440-1309
US

V. Phone/Fax

Practice location:
  • Phone: 651-439-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

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