Provider Demographics
NPI:1457836454
Name:GROUP HEALTH PLAN, INC
Entity Type:Organization
Organization Name:GROUP HEALTH PLAN, INC
Other - Org Name:HEALTHPARTNERS WELL@WORK ST. CLOUD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BJORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-883-7469
Mailing Address - Street 1:8170 33RD AVENUE S
Mailing Address - Street 2:MAILSTOP 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:430 GREAT OAK DRIVE
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387
Practice Address - Country:US
Practice Address - Phone:320-203-2400
Practice Address - Fax:320-203-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service