Provider Demographics
NPI:1740345958
Name:SHERIDAN COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:SHERIDAN COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LJILJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRICEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-291-6222
Mailing Address - Street 1:301 N MAIN STREET
Mailing Address - Street 2:PO BOX 279
Mailing Address - City:SHERIDAN
Mailing Address - State:MI
Mailing Address - Zip Code:48884-0279
Mailing Address - Country:US
Mailing Address - Phone:989-291-3261
Mailing Address - Fax:989-291-6121
Practice Address - Street 1:303 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MI
Practice Address - Zip Code:48884-0230
Practice Address - Country:US
Practice Address - Phone:989-291-5077
Practice Address - Fax:989-291-5348
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHERIDAN COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-27
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08E910090OtherGRP BLUECROSS PIN NUMBER
MI0P59300Medicare PIN
MI0M59260Medicare PIN