Provider Demographics
NPI:1073778130
Name:GROUP HEALTH
Entity Type:Organization
Organization Name:GROUP HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.T.A.
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:VANDEBRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-510-3896
Mailing Address - Street 1:11511 NE 10TH ST # 305
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8578
Mailing Address - Country:US
Mailing Address - Phone:425-502-3896
Mailing Address - Fax:
Practice Address - Street 1:11511 NE 10TH ST # 305
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8578
Practice Address - Country:US
Practice Address - Phone:425-502-3896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization