Healthcare Provider Details

I. General information

NPI: 1073778130
Provider Name (Legal Business Name): GROUP HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 NE 10TH ST # 305
BELLEVUE WA
98004-8578
US

IV. Provider business mailing address

11511 NE 10TH ST # 305
BELLEVUE WA
98004-8578
US

V. Phone/Fax

Practice location:
  • Phone: 425-502-3896
  • Fax:
Mailing address:
  • Phone: 425-502-3896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA J VANDEBRAKE
Title or Position: P.T.A.
Credential:
Phone: 425-510-3896