Provider Demographics
NPI:1205362449
Name:CHEYENNE COUNTY HOSPITAL ASSOCIATION INC
Entity Type:Organization
Organization Name:CHEYENNE COUNTY HOSPITAL ASSOCIATION INC
Other - Org Name:SIDNEY REGIONAL MEDICAL CENTER WALK IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:UTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-254-5064
Mailing Address - Street 1:1000 POLE CREEK XING
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-2900
Mailing Address - Country:US
Mailing Address - Phone:308-254-5825
Mailing Address - Fax:308-254-0869
Practice Address - Street 1:610 GLOVER RD STE 4
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-3050
Practice Address - Country:US
Practice Address - Phone:308-254-4752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHEYENNE COUNTY HOSPITAL ASSOCIATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-09
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty