| Prairie Ridge Health, Inc. | |
|
301 W Main St Marshall WI 53559-9799 | |
| (920) 623-2200 | |
| (920) 623-1441 |
| Full Name | Prairie Ridge Health, Inc. |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| 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 |