Provider Demographics
NPI: | 1164597720 |
---|---|
Name: | SHERIDAN MEMORIAL HOSPITAL ASSOCIATION |
Entity Type: | Organization |
Organization Name: | SHERIDAN MEMORIAL HOSPITAL ASSOCIATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | WAYNE |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | NELSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 406-765-3700 |
Mailing Address - Street 1: | 440 W LAUREL AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | PLENTYWOOD |
Mailing Address - State: | MT |
Mailing Address - Zip Code: | 59254-1526 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 406-765-3700 |
Mailing Address - Fax: | 406-765-3800 |
Practice Address - Street 1: | 440 W LAUREL AVE |
Practice Address - Street 2: | |
Practice Address - City: | PLENTYWOOD |
Practice Address - State: | MT |
Practice Address - Zip Code: | 59254-1526 |
Practice Address - Country: | US |
Practice Address - Phone: | 406-765-3700 |
Practice Address - Fax: | 406-765-3800 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-21 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MT | 10179 | 282NC0060X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 282NC0060X | Hospitals | General Acute Care Hospital | Critical Access |