Provider Demographics
NPI:1730109349
Name:PARTNERSHIP HEALTH PLAN, INC.
Entity Type:Organization
Organization Name:PARTNERSHIP HEALTH PLAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-838-2901
Mailing Address - Street 1:2240 EASTRIDGE CTR
Mailing Address - Street 2:
Mailing Address - City:EAU CLARIE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3410
Mailing Address - Country:US
Mailing Address - Phone:715-838-2900
Mailing Address - Fax:715-838-2910
Practice Address - Street 1:2240 EASTRIDGE CTR
Practice Address - Street 2:
Practice Address - City:EAU CLARIE
Practice Address - State:WI
Practice Address - Zip Code:54701-3410
Practice Address - Country:US
Practice Address - Phone:715-838-2900
Practice Address - Fax:715-838-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI69005200Medicaid
H5206Medicare ID - Type Unspecified