Provider Demographics
NPI:1407838329
Name:PRAIRIE RIDGE HOSPITAL AND HEALTH SERVICES
Entity Type:Organization
Organization Name:PRAIRIE RIDGE HOSPITAL AND HEALTH SERVICES
Other - Org Name:LAKE REGION HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-736-8687
Mailing Address - Street 1:1411 HWY 79E
Mailing Address - Street 2:
Mailing Address - City:ELBOW LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56531-4605
Mailing Address - Country:US
Mailing Address - Phone:218-685-7300
Mailing Address - Fax:218-685-7296
Practice Address - Street 1:1411 HWY 79E
Practice Address - Street 2:
Practice Address - City:ELBOW LAKE
Practice Address - State:MN
Practice Address - Zip Code:56531-4605
Practice Address - Country:US
Practice Address - Phone:218-685-7300
Practice Address - Fax:218-685-7296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00154282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN241379OtherNORIDIAN MEDICARE
MN24Z379OtherNORIDIAN MEDICARE SWINGBED
MNC06639OtherWPS MEDICARE
241379Medicare UPIN
MN24Z379Medicare Oscar/Certification
MNC06639OtherWPS MEDICARE