Healthcare Provider Details

I. General information

NPI: 1568418192
Provider Name (Legal Business Name): SOUTH SHERIDAN MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1842 SUGARLAND DRIVE SUITE 103
SHERIDAN WY
82801-5719
US

IV. Provider business mailing address

1842 SUGARLAND DRIVE SUITE 103
SHERIDAN WY
82801-5719
US

V. Phone/Fax

Practice location:
  • Phone: 307-673-4960
  • Fax: 307-673-4951
Mailing address:
  • Phone: 307-673-4960
  • Fax: 307-673-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number240
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN WAYNE FINLEY
Title or Position: C.E.O.
Credential: M.D.
Phone: 307-673-4960