Provider Demographics
NPI:1568418192
Name:SOUTH SHERIDAN MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:SOUTH SHERIDAN MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-673-4960
Mailing Address - Street 1:1842 SUGARLAND DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5719
Mailing Address - Country:US
Mailing Address - Phone:307-673-4960
Mailing Address - Fax:307-673-4951
Practice Address - Street 1:1842 SUGARLAND DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5719
Practice Address - Country:US
Practice Address - Phone:307-673-4960
Practice Address - Fax:307-673-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
WY240363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120483100Medicaid
WY120483100Medicaid