Healthcare Provider Details

I. General information

NPI: 1538858238
Provider Name (Legal Business Name): CHEYENNE COUNTY HOSPITAL ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 GLOVER RD STE 3
SIDNEY NE
69162-3050
US

IV. Provider business mailing address

1000 POLE CREEK XING
SIDNEY NE
69162-2901
US

V. Phone/Fax

Practice location:
  • Phone: 308-254-5825
  • Fax:
Mailing address:
  • Phone: 308-254-5825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY K UTLEY
Title or Position: CFO
Credential:
Phone: 308-254-5064