Organization
PRAIRIE RIDGE HEALTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELISSA MANGAN (VICE PRESIDENT/CFO)
(920) 623-8453
Entity
Organization
Contact information
Practice address
1515 PARK AVE, COLUMBUS, WI 53925-2402
(920) 623-2200
(920) 623-1441
Mailing address
1515 PARK AVE, COLUMBUS, WI 53925-2402
(920) 623-2200
(920) 623-1441
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
278-800
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11012810
—
WI
05
—
32763600
—
WI
05
—
36200200
—
WI
05
—
41172200
—
WI
05
—
43414600
—
WV
01
—
WI0100
JOHN DEERE EKG, RT
WI
01
—
WI0104
JOHN DEERE ER/UC
WI
01
—
WI0105
JOHN DEERE CRNA
WI
Enumeration date
10/20/2006
Last updated
07/30/2020
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