Basic Information
| Provider Information | |||||||||
| NPI: | 1083175384 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SHERIDAN COUNTY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 826 18TH ST | ||||||||
| Address2: | |||||||||
| City: | HOXIE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 677404371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856753018 | ||||||||
| FaxNumber: | 7856752306 | ||||||||
| Practice Location | |||||||||
| Address1: | 826 18TH ST | ||||||||
| Address2: | |||||||||
| City: | HOXIE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 677404371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856753018 | ||||||||
| FaxNumber: | 7856752306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2019 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | POPP | ||||||||
| AuthorizedOfficialFirstName: | PAM | ||||||||
| AuthorizedOfficialMiddleName: | ROSE | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7856753018 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOSPITAL | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.