Provider Demographics
NPI:1487732467
Name:PRAIRIE ANESTHESIA SERVICES SC
Entity type:Organization
Organization Name:PRAIRIE ANESTHESIA SERVICES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:FALCH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:608-326-8368
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-0338
Mailing Address - Country:US
Mailing Address - Phone:608-357-2000
Mailing Address - Fax:608-357-2254
Practice Address - Street 1:705 E TAYLOR ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-2110
Practice Address - Country:US
Practice Address - Phone:608-357-2000
Practice Address - Fax:608-357-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61903-030367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43272400Medicaid
IA0944181Medicaid
WI000014009Medicare ID - Type Unspecified