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NPI Code Detail

MEDICARE: GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN

MEDICARE: GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN
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
13336C0002XClinic Pharmacy
23336M0003XManaged Care Organization Pharmacy7476-42WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12108703OTHERPK

General Provider Information

NPI Number : 1255342754
Entity Type Code : Organization
Provider Name (Legal Business Name) : GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN
Provider Business Mailing Address
First Line : PO BOX 44971
Second Line :
City : MADISON
State : WI
Zip : 53744-4971
Country : US
Telephone Number : 608-828-4811
Fax Number : 608-828-4810
Provider Business Practice Location Address
First Line : 675 W WASHINGTON AVE
Second Line :
City : MADISON
State : WI
Zip : 53703-2637
Country : US
Telephone Number : 608-257-5178
Fax Number : 608-252-1401
Authorized Official
Title or Position : PHARMACY OPERATIONS
Name : LAURIE FLAGEL DEAN
Credential : RPH
Telephone Number : 608-828-4811
Provider Enumeration Date : 08/10/2006
Last Update Date : 08/08/2013

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