Provider Demographics
NPI:1598195208
Name:PRAIRIE HEALTH CLINIC
Entity Type:Organization
Organization Name:PRAIRIE HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEUGEBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-724-2151
Mailing Address - Street 1:708 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ARMOUR
Mailing Address - State:SD
Mailing Address - Zip Code:57313-2102
Mailing Address - Country:US
Mailing Address - Phone:605-724-2151
Mailing Address - Fax:605-724-2310
Practice Address - Street 1:708 8TH ST
Practice Address - Street 2:
Practice Address - City:ARMOUR
Practice Address - State:SD
Practice Address - Zip Code:57313-2102
Practice Address - Country:US
Practice Address - Phone:605-724-2151
Practice Address - Fax:605-724-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty