Healthcare Provider Details

I. General information

NPI: 1295800738
Provider Name (Legal Business Name): GROUP HEALTH COOPERATIVE OF EAU CLAIRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 N HILLCREST PKWY
ALTOONA WI
54720-2569
US

IV. Provider business mailing address

2503 N HILLCREST PKWY
ALTOONA WI
54720-2569
US

V. Phone/Fax

Practice location:
  • Phone: 715-552-4300
  • Fax: 715-836-7683
Mailing address:
  • Phone:
  • Fax: 715-836-7683

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: MR. PETER FARROW
Title or Position: GENERAL MANAGER
Credential:
Phone: 715-552-4300