Organization
PRAIRIE RIDGE HEALTH, INC.
Active
Parent organization
COLUMBUS COMMUNITY HOSPITAL, INC
Other names
Prairie Ridge Health Clinic, Columbus Community Hospital, Inc.
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLUMBUS COMMUNITY HOSPITAL, INC
Authorized official
MR. JOHN RUSSELL (PRESIDENT & CEO)
(920) 623-1368
Entity
Organization
Contact information
Practice address
301 W MAIN ST, MARSHALL, WI 53559-9799
(920) 623-2200
(920) 623-1441
Mailing address
PO BOX 418, MARSHALL, WI 53559-0418
(608) 655-8181
(608) 655-8224
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
21498-20
WI
364SF0001X
Family Health Clinical Nurse Specialist
2985
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52D2123598
CLIA NUMBER
WI
Enumeration date
10/25/2016
Last updated
08/26/2022
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