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General NPI Number Information
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NPI Number | 1073668877
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Entity Type | Organization
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Legal Business Name | GROUP HEALTH PLAN
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 15350 ENGLISH AVE
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City | APPLE VALLEY
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State | MN
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Zip | 55124-6252
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Country | US
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Telephone | 952-431-8583
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Fax | 952-431-8528
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Provider Business Mailing Address
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Address Line | 8170 33RD AVE S # 21113A
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City | BLOOMINGTON
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State | MN
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Zip | 55425-4516
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Country | US
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Telephone | 952-883-5151
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Fax | 952-883-5160
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Authorized Official
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Title or Position | CAO
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Name | KATHLEEN M COONEY
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Credential |
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Telephone | 952-883-7565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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