=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225003445
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAUK PRAIRIE HEALTHCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2006
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 VALLEY DR
-----------------------------------------------------
City | LODI
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53555-1464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-592-3296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 VALLEY DR
-----------------------------------------------------
City | LODI
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53555-1464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | JAMES DREGNEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 608-643-7212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------