Healthcare Provider Details

I. General information

NPI: 1184289043
Provider Name (Legal Business Name): SHERIDAN COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date: 06/18/2021
Reactivation Date: 07/09/2021

III. Provider practice location address

301 N MAIN ST
SHERIDAN MI
48884-0279
US

IV. Provider business mailing address

301 N MAIN ST PO BOX 279
SHERIDAN MI
48884-0279
US

V. Phone/Fax

Practice location:
  • Phone: 989-291-3261
  • Fax: 989-291-3062
Mailing address:
  • Phone: 989-291-3261
  • Fax: 989-291-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LJILJANA PETRICEVIC
Title or Position: CEO
Credential:
Phone: 989-291-6222