Provider Demographics
NPI:1144775404
Name:UNITED HEALTH GROUP
Entity Type:Organization
Organization Name:UNITED HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD, R.PH.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-889-9604
Mailing Address - Street 1:PO BOX 994
Mailing Address - Street 2:
Mailing Address - City:INDIAN ROCKS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33785-0994
Mailing Address - Country:US
Mailing Address - Phone:303-889-9604
Mailing Address - Fax:
Practice Address - Street 1:19811 GULF BLVD
Practice Address - Street 2:401
Practice Address - City:INDIAN SHORES
Practice Address - State:FL
Practice Address - Zip Code:33785-2387
Practice Address - Country:US
Practice Address - Phone:303-889-9604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL53616305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service