Basic Information
| Provider Information | |||||||||
| NPI: | 1528196136 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHERIDAN RADIOLOGY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 W 5TH ST STE 100 | ||||||||
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| City: | SHERIDAN | ||||||||
| State: | WY | ||||||||
| PostalCode: | 828012751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076721000 | ||||||||
| FaxNumber: | 3076721174 | ||||||||
| Practice Location | |||||||||
| Address1: | 1333 W 5TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | SHERIDAN | ||||||||
| State: | WY | ||||||||
| PostalCode: | 828012751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076721000 | ||||||||
| FaxNumber: | 3076721174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCAFFERTY | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3076721044 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | 07199 | WY | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.