Healthcare Provider Details

I. General information

NPI: 1528196136
Provider Name (Legal Business Name): SHERIDAN RADIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 W 5TH ST STE 100
SHERIDAN WY
82801-2751
US

IV. Provider business mailing address

1333 W 5TH ST STE 100
SHERIDAN WY
82801-2751
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 Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number07199
License Number StateWY

VIII. Authorized Official

Name: MICHAEL MCCAFFERTY
Title or Position: CEO
Credential:
Phone: 307-672-1044