Prairie Ridge Health, Inc. | |
301 W Main St Marshall WI 53559-9799 | |
(920) 623-2200 | |
(920) 623-1441 |
Full Name | Prairie Ridge Health, Inc. |
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Speciality | Clinic/center - Primary Care |
Location | 301 W Main St, Marshall, Wisconsin |
Authorized Official Name and Position | John Russell (PRESIDENT & CEO) |
Authorized Official Contact | 9206231368 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Prairie Ridge Health, Inc. Po Box 418 Marshall WI 53559-0418 Ph: (608) 655-8181 | Prairie Ridge Health, Inc. 301 W Main St Marshall WI 53559-9799 Ph: (920) 623-2200 |
NPI Number | 1477005544 |
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Provider Enumeration Date | 10/25/2016 |
Last Update Date | 08/26/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1477005544 | NPI | - | NPPES |
52D2123598 | Other | WI | CLIA NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 21498-20 (Wisconsin) | Primary |
364SF0001X | Clinical Nurse Specialist - Family Health | 2985 (Wisconsin) | Secondary |