Provider Demographics
NPI:1740425057
Name:SAUK PRAIRIE HEALTHCARE INC
Entity Type:Organization
Organization Name:SAUK PRAIRIE HEALTHCARE INC
Other - Org Name:INTERNAL MEDICINE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DREGNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-643-7212
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-0160
Mailing Address - Country:US
Mailing Address - Phone:608-643-3311
Mailing Address - Fax:
Practice Address - Street 1:260 26TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-1599
Practice Address - Country:US
Practice Address - Phone:608-643-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA6064OtherRAILROAD MEDICARE
WI100001867Medicaid
WI100001867Medicaid
0752040001Medicare NSC