Provider Demographics
NPI:1861466153
Name:SAUK PRAIRIE HEALTHCARE INC
Entity Type:Organization
Organization Name:SAUK PRAIRIE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
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 70
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-0070
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:2006-02-14
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3945800282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40427200OtherMA LODI THERAPY
WI40427300OtherMA RIVER VALLEY THERAPY
WI11013600OtherMEDICAID PROVIDER NUMBER
WI21160OtherMEDICARE CRNA
WI41119100OtherMA AUDIOLOGY
WI52U095OtherMEDICARE SWINGBED
WI32944900OtherMA REFERRED LABS
WI00495OtherMEDICARE PROVIDER NUMBER
WI520095OtherMEDICARE PROVIDER NUMBER
WI520095OtherMEDICARE PROVIDER NUMBER