Provider Demographics
NPI:1467682039
Name:PRAIRIE LAKES HEALTHCARE SYSTEMS INC
Entity Type:Organization
Organization Name:PRAIRIE LAKES HEALTHCARE SYSTEMS INC
Other - Org Name:PRAIRIE LAKES PERITONEAL DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURBAK
Authorized Official - Suffix:
Authorized Official - Credentials:CNO
Authorized Official - Phone:605-882-7000
Mailing Address - Street 1:401 9TH AVE NW
Mailing Address - Street 2:PO BOX 1210
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-1548
Mailing Address - Country:US
Mailing Address - Phone:605-882-7000
Mailing Address - Fax:
Practice Address - Street 1:401 9TH AVE NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1548
Practice Address - Country:US
Practice Address - Phone:605-882-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10572261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment