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General NPI Number Information
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NPI Number | 1053411280
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Entity Type | Organization
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Legal Business Name | PRAIRIE SURGICENTER LLP
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 24 E 7TH ST SUITE 100
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City | MORRIS
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State | MN
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Zip | 56267-1312
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Country | US
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Telephone | 320-208-1818
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Fax | 320-208-1845
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Provider Business Mailing Address
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Address Line | 24 E 7TH ST SUITE 100
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City | MORRIS
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State | MN
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Zip | 56267-1312
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN F STOCK
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Credential | M.D.
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Telephone | 320-208-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 5887419
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License Number State | MN
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