Healthcare Provider Details

I. General information

NPI: 1205362449
Provider Name (Legal Business Name): CHEYENNE COUNTY HOSPITAL ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2017
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 GLOVER RD STE 4
SIDNEY NE
69162-3050
US

IV. Provider business mailing address

1000 POLE CREEK XING
SIDNEY NE
69162-2900
US

V. Phone/Fax

Practice location:
  • Phone: 308-254-4752
  • Fax:
Mailing address:
  • Phone: 308-254-5825
  • Fax: 308-254-0869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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