Provider Demographics
NPI:1467452102
Name:SHERIDAN MEMORIAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:SHERIDAN MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KODAY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-765-3700
Mailing Address - Street 1:440 W LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:PLENTYWOOD
Mailing Address - State:MT
Mailing Address - Zip Code:59254-1526
Mailing Address - Country:US
Mailing Address - Phone:406-765-3700
Mailing Address - Fax:406-765-3800
Practice Address - Street 1:440 W LAUREL AVE
Practice Address - Street 2:
Practice Address - City:PLENTYWOOD
Practice Address - State:MT
Practice Address - Zip Code:59254-1526
Practice Address - Country:US
Practice Address - Phone:406-765-3700
Practice Address - Fax:406-765-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
MT12506282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0412556Medicaid
MT0442546Medicaid
MT0356720Medicaid
MT60792OtherBC BS
MT60792OtherBC BS
MT0442546Medicaid
MT000071765Medicare ID - Type UnspecifiedFRANK THOMPSON, MD
MT000085477Medicare ID - Type UnspecifiedMARK HEGYES, MD
MT271322Medicare Oscar/Certification
MT000009982Medicare ID - Type UnspecifiedGROUP NUMBER PHYSICIANS
MT0356720Medicaid
MT0412556Medicaid
MT000071547Medicare ID - Type UnspecifiedDWIGHT THOMPSON
MT000071723Medicare ID - Type UnspecifiedLEXI GULBRANSON, MD