Provider Demographics
NPI:1528196136
Name:SHERIDAN RADIOLOGY, LLC
Entity Type:Organization
Organization Name:SHERIDAN RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAFFERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-672-1044
Mailing Address - Street 1:1333 W 5TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2751
Mailing Address - Country:US
Mailing Address - Phone:307-672-1000
Mailing Address - Fax:307-672-1174
Practice Address - Street 1:1333 W 5TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2751
Practice Address - Country:US
Practice Address - Phone:307-672-1000
Practice Address - Fax:307-672-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY07199261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
20664Medicare ID - Type Unspecified