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General NPI Number Information
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NPI Number | 1841376183
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Entity Type | Organization
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Legal Business Name | PRAIRIE RIDGE HEALTH, INC.
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Dates
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Enumeration Date | 10/30/2006
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 1515 PARK AVE
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City | COLUMBUS
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State | WI
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Zip | 53925-2402
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Country | US
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Telephone | 920-623-2200
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Fax | 920-623-1441
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Provider Business Mailing Address
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Address Line | 1515 PARK AVE
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City | COLUMBUS
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State | WI
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Zip | 53925-2402
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Country | US
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Telephone | 920-623-2200
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Fax | 920-623-1441
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. JOHN RUSSELL
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Credential |
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Telephone | 920-623-1368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 278-800
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License Number State | WI
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