Provider Demographics
NPI:1871681437
Name:COUNTY OF SHERIDAN
Entity Type:Organization
Organization Name:COUNTY OF SHERIDAN
Other - Org Name:SHERIDAN COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-672-5169
Mailing Address - Street 1:297 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801
Mailing Address - Country:US
Mailing Address - Phone:307-672-5169
Mailing Address - Fax:307-672-5186
Practice Address - Street 1:297 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801
Practice Address - Country:US
Practice Address - Phone:307-672-5169
Practice Address - Fax:307-672-5186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHERIDAN COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-10
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY07-006251B00000X, 251K00000X
WY251B00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY100059400Medicaid
WY310015OtherKID CARE CHIP
WY600002639Medicare PIN
WY310015OtherKID CARE CHIP
WYW9409Medicare PIN
WY9409Medicare PIN