Healthcare Provider Details

I. General information

NPI: 1487732467
Provider Name (Legal Business Name): PRAIRIE ANESTHESIA SERVICES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E TAYLOR ST
PRAIRIE DU CHIEN WI
53821-2110
US

IV. Provider business mailing address

PO BOX 338
PRAIRIE DU CHIEN WI
53821-0338
US

V. Phone/Fax

Practice location:
  • Phone: 608-357-2000
  • Fax: 608-357-2254
Mailing address:
  • Phone: 608-357-2000
  • Fax: 608-357-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number61903-030
License Number StateWI

VIII. Authorized Official

Name: MR. RONALD F FALCH
Title or Position: OWNER
Credential: CRNA
Phone: 608-326-8368