Healthcare Provider Details

I. General information

NPI: 1740345958
Provider Name (Legal Business Name): SHERIDAN COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 CONGRESS ST
SHERIDAN MI
48884-0230
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 989-291-5077
  • Fax: 989-291-5348
Mailing address:
  • Phone: 989-291-3261
  • Fax: 989-291-6121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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