Healthcare Provider Details

I. General information

NPI: 1841366226
Provider Name (Legal Business Name): GROUP HEALTH COOPERATIVE OF EAU CLAIRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 CRAIG RD
EAU CLAIRE WI
54701-6186
US

IV. Provider business mailing address

3110 CRAIG RD
EAU CLAIRE WI
54701-6186
US

V. Phone/Fax

Practice location:
  • Phone: 715-552-7227
  • Fax:
Mailing address:
  • Phone: 715-552-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

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