MEDICARE: SOUTH SHERIDAN MEDICAL CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	240	WY
2	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568418192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH SHERIDAN MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	1842 SUGARLAND DRIVE
Second Line	:	SUITE 103
City	:	SHERIDAN
State	:	WY
Zip	:	82801-5719
Country	:	US
Telephone Number	:	307-673-4960
Fax Number	:	307-673-4951

Provider Business Practice Location Address
First Line	:	1842 SUGARLAND DRIVE
Second Line	:	SUITE 103
City	:	SHERIDAN
State	:	WY
Zip	:	82801-5719
Country	:	US
Telephone Number	:	307-673-4960
Fax Number	:	307-673-4951

Authorized Official
Title or Position	:	C.E.O.
Name	:	JOHN WAYNE FINLEY
Credential	:	M.D.
Telephone Number	:	307-673-4960

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	06/04/2013

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