Provider Demographics
NPI:1962704346
Name:GROUP HEALTH PLAN, INC.
Entity type:Organization
Organization Name:GROUP HEALTH PLAN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:DZIUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-883-6535
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MAILSTOP 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-7469
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:2100 3RD AVE
Practice Address - Street 2:ANOKA COUNTY GOVERNMENT CENTER
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2235
Practice Address - Country:US
Practice Address - Phone:952-883-7598
Practice Address - Fax:952-883-8732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service