Provider Demographics
NPI:1528090594
Name:SHERIDAN COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:SHERIDAN COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LJILJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRICEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-291-6222
Mailing Address - Street 1:301 N MAIN ST
Mailing Address - Street 2:PO BOX 279
Mailing Address - City:SHERIDAN
Mailing Address - State:MI
Mailing Address - Zip Code:48884-0279
Mailing Address - Country:US
Mailing Address - Phone:989-291-3261
Mailing Address - Fax:989-291-3062
Practice Address - Street 1:301 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MI
Practice Address - Zip Code:48884-0279
Practice Address - Country:US
Practice Address - Phone:989-291-3261
Practice Address - Fax:989-291-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E96007OtherBCBSM GROUP
MI17827OtherPRIORITY HEALTH
MI0E96007Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER