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General NPI Number Information
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NPI Number | 1962986927
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Entity Type | Organization
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Legal Business Name | GROUP HEALTH PLAN, INC
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Dates
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Enumeration Date | 09/17/2018
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Last Update Date | 09/21/2018
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Provider Practice Location Address
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Address Line | 2165 WHITE BEAR AVE N
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City | MAPLEWOOD
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State | MN
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Zip | 55109-2707
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Country | US
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Telephone | 952-967-6278
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Fax |
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Provider Business Mailing Address
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Address Line | 8170 33RD AVE SOUTH MAILSTOP 21110Q - LISA L BJORKMAN
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City | BLOOMINGTON
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State | MN
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Zip | 55425
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Country | US
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Telephone | 952-883-7469
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LISA BJORKMAN
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Credential |
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Telephone | 952-883-7469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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