Provider Demographics
NPI:1831648500
Name:PRAIRIE RIDGE HOSPITAL AND HEALTH SERVICES
Entity Type:Organization
Organization Name:PRAIRIE RIDGE HOSPITAL AND HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-685-7327
Mailing Address - Street 1:1411 HIGHWAY 79 E
Mailing Address - Street 2:
Mailing Address - City:ELBOW LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56531-4645
Mailing Address - Country:US
Mailing Address - Phone:218-685-7300
Mailing Address - Fax:218-685-7296
Practice Address - Street 1:204 5TH ST E
Practice Address - Street 2:
Practice Address - City:HERMAN
Practice Address - State:MN
Practice Address - Zip Code:56248-6248
Practice Address - Country:US
Practice Address - Phone:320-677-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care