Basic Information
| Provider Information | |||||||||
| NPI: | 1114033966 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SHERIDAN COUNTY HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | SELDEN COMMUNITY CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 826 18TH STREET | ||||||||
| Address2: | |||||||||
| City: | HOXIE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 677400415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856753018 | ||||||||
| FaxNumber: | 7856752306 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 N. KANSAS | ||||||||
| Address2: | |||||||||
| City: | SELDEN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853864380 | ||||||||
| FaxNumber: | 7853864380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | STRATTON | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7856753281 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.