Provider Demographics
NPI:1013083930
Name:COUNTY OF SHERIDAN
Entity Type:Organization
Organization Name:COUNTY OF SHERIDAN
Other - Org Name:SHERIDAN COUNTY PUBLIC HEALTH DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:406-765-3410
Mailing Address - Street 1:100 W LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:PLENTYWOOD
Mailing Address - State:MT
Mailing Address - Zip Code:59254-1647
Mailing Address - Country:US
Mailing Address - Phone:406-765-3410
Mailing Address - Fax:406-765-3495
Practice Address - Street 1:100 W LAUREL AVE
Practice Address - Street 2:
Practice Address - City:PLENTYWOOD
Practice Address - State:MT
Practice Address - Zip Code:59254-1647
Practice Address - Country:US
Practice Address - Phone:406-765-3410
Practice Address - Fax:406-765-3495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7753428Medicaid
MT0350863Medicaid
MT3607Medicare ID - Type UnspecifiedBLUE CROSS BLUE SHIELD MT