MEDICARE: GROUP HEALTH PLAN INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	8600490	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194886002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROUP HEALTH PLAN INC.

Provider Business Mailing Address
First Line	:	8170 33RD AVE S
Second Line	:	MAIL STOP 21110Q
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-4516
Country	:	US
Telephone Number	:	952-883-7469
Fax Number	:	952-853-8727

Provider Business Practice Location Address
First Line	:	1665 UTICA AVENUE SOUTH
Second Line	:	SUITE 100
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1521
Country	:	US
Telephone Number	:	952-967-7720
Fax Number	:	952-541-2539

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LISA BJORKMAN
Credential	:
Telephone Number	:	952-883-7469

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/16/2023

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Directions to “GROUP HEALTH PLAN INC. ” Practice Location

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