Provider Demographics
NPI:1285686642
Name:SANDHILLS DISTRICT HEALTH DEPARTMENT & CLINIC
Entity Type:Organization
Organization Name:SANDHILLS DISTRICT HEALTH DEPARTMENT & CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:THEILER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:308-284-6054
Mailing Address - Street 1:55 RIVER RD
Mailing Address - Street 2:POB 784
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153-3009
Mailing Address - Country:US
Mailing Address - Phone:308-284-6054
Mailing Address - Fax:308-284-4833
Practice Address - Street 1:55 RIVER RD
Practice Address - Street 2:POB 784
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-3009
Practice Address - Country:US
Practice Address - Phone:308-284-6054
Practice Address - Fax:308-284-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025359200Medicaid
263819Medicare ID - Type Unspecified