Provider Demographics
NPI:1336408038
Name:PRAIRIE SURGICARE, LLC
Entity type:Organization
Organization Name:PRAIRIE SURGICARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD, FACSS
Authorized Official - Phone:309-691-7774
Mailing Address - Street 1:7620 N UNIVERSITY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-8300
Mailing Address - Country:US
Mailing Address - Phone:309-691-7774
Mailing Address - Fax:309-689-5768
Practice Address - Street 1:7620 N UNIVERSITY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-8300
Practice Address - Country:US
Practice Address - Phone:309-691-7774
Practice Address - Fax:309-689-5768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical