Healthcare Provider Details

I. General information

NPI: 1851420939
Provider Name (Legal Business Name): MEMORIAL HOSPITAL OF SHERIDAN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W 5TH ST
SHERIDAN WY
82801-2705
US

IV. Provider business mailing address

1401 W 5TH ST
SHERIDAN WY
82801-2705
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-1000
  • Fax: 307-672-1174
Mailing address:
  • Phone: 307-672-1000
  • Fax: 307-672-1174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number07199
License Number StateWY

VIII. Authorized Official

Name: NATHAN STUTTE
Title or Position: CFO
Credential:
Phone: 307-672-1000