Provider Demographics
NPI:1467452102
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:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
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:2005-07-22
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12506282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT60792OtherBC BS
MT0356720Medicaid
MT0412556Medicaid
MT0442546Medicaid
MT60792OtherBC BS
MT0442546Medicaid
MT000071765Medicare ID - Type UnspecifiedFRANK THOMPSON, MD
MT000085477Medicare ID - Type UnspecifiedMARK HEGYES, MD
MT271322Medicare Oscar/Certification
MT000009982Medicare ID - Type UnspecifiedGROUP NUMBER PHYSICIANS
MT0356720Medicaid
MT0412556Medicaid
MT000071547Medicare ID - Type UnspecifiedDWIGHT THOMPSON
MT000071723Medicare ID - Type UnspecifiedLEXI GULBRANSON, MD