Provider Demographics
NPI:1215231311
Name:PRAIRIE ENTERPRISES LLC
Entity Type:Organization
Organization Name:PRAIRIE ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAIRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-998-6359
Mailing Address - Street 1:3332 N BOULDER CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5553
Mailing Address - Country:US
Mailing Address - Phone:800-998-6359
Mailing Address - Fax:800-886-3594
Practice Address - Street 1:3332 N BOULDER CREEK AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5553
Practice Address - Country:US
Practice Address - Phone:800-998-6359
Practice Address - Fax:800-886-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies