Provider Demographics
NPI:1790112621
Name:GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WI
Entity Type:Organization
Organization Name:GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-256-4156
Mailing Address - Street 1:1265 JOHN Q HAMMONS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717
Mailing Address - Country:US
Mailing Address - Phone:608-251-4156
Mailing Address - Fax:
Practice Address - Street 1:8054 WATTS RD.
Practice Address - Street 2:PRINCETON WEST
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719
Practice Address - Country:US
Practice Address - Phone:608-662-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies