| Organization Name: | PRAIRIE CLINIC, SC |
| NPI Number: | 1215349196 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEVEN J JOHNSON (MEDICAL DOCTOR) |
| Mailing Address: | 112 Helen St Sauk City |
| State: | WI US |
| Postal Code: | 535831101 |
| Phone Number: | 6086433351 |
| Fax Number: | 6086433621 |
| NPI Enumeration Date: | 05/27/2014 |
| NPI Last Update Date: | 05/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |