Provider Demographics
NPI:1740372754
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 ST
Mailing Address - Street 2:PO BOX 155
Mailing Address - City:SHERIDAN
Mailing Address - State:MI
Mailing Address - Zip Code:48884-0155
Mailing Address - Country:US
Mailing Address - Phone:989-291-6400
Mailing Address - Fax:989-291-5350
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:989-291-4348
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHERIDAN COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-28
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI238565Medicare Oscar/Certification