Healthcare Provider Details

I. General information

NPI: 1346340130
Provider Name (Legal Business Name): CITY OF SHERIDAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S SCOTT ST
SHERIDAN WY
82801-6309
US

IV. Provider business mailing address

PO BOX 767
SHERIDAN WY
82801-0767
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-6126
  • Fax:
Mailing address:
  • Phone: 307-672-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number100
License Number StateWY

VIII. Authorized Official

Name: PATRICK REITZ
Title or Position: FIRE CHIEF
Credential:
Phone: 307-672-6126