Provider Demographics
NPI:1902449309
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:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-337-4280
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:952-653-2565
Mailing Address - Fax:952-653-2540
Practice Address - Street 1:1411 HIGHWAY 79 E
Practice Address - Street 2:
Practice Address - City:ELBOW LAKE
Practice Address - State:MN
Practice Address - Zip Code:56531-4645
Practice Address - Country:US
Practice Address - Phone:952-653-2565
Practice Address - Fax:952-653-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty