Healthcare Provider Details

I. General information

NPI: 1740895952
Provider Name (Legal Business Name): CHEYENNE COUNTY HOSPITAL ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 POLE CREEK XING
SIDNEY NE
69162-2900
US

IV. Provider business mailing address

1000 POLE CREEK XING
SIDNEY NE
69162-2900
US

V. Phone/Fax

Practice location:
  • Phone: 308-254-5064
  • Fax: 402-254-2300
Mailing address:
  • Phone: 308-254-5825
  • Fax: 402-254-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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