Provider Demographics
NPI:1942316799
Name:SHERIDAN COUNTY HOSPITAL
Entity Type:Organization
Organization Name:SHERIDAN COUNTY HOSPITAL
Other - Org Name:HOXIE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICETA
Authorized Official - Middle Name:B
Authorized Official - Last Name:FARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-675-3281
Mailing Address - Street 1:826 18TH ST STE A
Mailing Address - Street 2:PO BOX 415
Mailing Address - City:HOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:67740-4373
Mailing Address - Country:US
Mailing Address - Phone:785-675-3018
Mailing Address - Fax:785-675-2306
Practice Address - Street 1:826 18TH ST STE A
Practice Address - Street 2:BOX 415
Practice Address - City:HOXIE
Practice Address - State:KS
Practice Address - Zip Code:67740-4373
Practice Address - Country:US
Practice Address - Phone:785-675-3018
Practice Address - Fax:785-675-2306
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHERIDAN COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-22
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110255OtherBLUE CROSS
KS100009640BMedicaid
KS1188OtherBLUE CROSS RHC
KS171863Medicare Oscar/Certification
KS110255Medicare PIN
KS110255OtherBLUE CROSS