Healthcare Provider Details

I. General information

NPI: 1538111265
Provider Name (Legal Business Name): SHERIDAN MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W LAUREL AVE
PLENTYWOOD MT
59254-1526
US

IV. Provider business mailing address

440 W LAUREL AVE
PLENTYWOOD MT
59254-1526
US

V. Phone/Fax

Practice location:
  • Phone: 406-765-3700
  • Fax: 406-765-3800
Mailing address:
  • Phone: 406-765-3700
  • Fax: 406-765-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number10333
License Number StateMT

VIII. Authorized Official

Name: SANDRA CHRISTENSEN
Title or Position: CEO
Credential:
Phone: 406-765-3700