NPIMap

Organization Active NPI

Sheridan Memorial Hospital Association

  • Rural Health Clinic/Center
  • Plentywood, MT
National Provider Identifier
1396970638
Registry record updated Nov 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SHERIDAN MEMORIAL HOSPITAL ASSOCIATION
Practice address
440 W Laurel Ave
Plentywood, MT 59254-1526
Phone
(406) 765-3700
Fax
(406) 765-3800
NPI assigned
May 15, 2009
Last updated
Nov 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Sandra Christensen
Title
Ceo
Phone
(406) 765-3700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

440 W Laurel Ave
Plentywood, MT 59254-1526

Mailing address

440 W Laurel Ave
Plentywood, MT 59254-1526
Phone (406) 765-3700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100129000534 MT Part A Provider - Rural Health Clinic 9133038706 Practice locations: Plentywood, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396970638. Details of each certification follow.

Rural health clinic certification: CCN 273417

Legal name
SHERIDAN MEMORIAL HOSPITAL ASSOCIATION
Doing business as
SHERIDAN MEMORIAL RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 1, 2010
Last certification
Jul 9, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 1922 in MT
Enrollment address
440W Laurel Ave
Plentywood, MT 59254-1596
Related CCNs
271322

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
27D1103886Sheridan Memorial Clinic440 West Laurel Ave, Plentywood, MT 59254Certificate of waiverAug 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Amb Serv7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Laura Rusbult Individual W-2 Managing Employee Apr 25, 1981
Donald Benson Individual Corporate Director Mar 22, 2017
Christopher Wiens Individual Corporate Director Feb 21, 2023
Nancy Jensen Individual Corporate Director Aug 23, 2017
Kody Nelson Individual Corporate OfficerCeo Aug 21, 2020
Myrnette Miller Individual Corporate Director Mar 1, 2011
Cory Sampsen Individual Corporate Director Feb 16, 2021
Paul Hansen Individual Corporate Director Feb 16, 2021

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288915200000",
    "number": "1396970638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 W LAUREL AVE",
            "city": "PLENTYWOOD",
            "state": "MT",
            "postal_code": "592541526",
            "telephone_number": "406-765-3700",
            "fax_number": "406-765-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 W LAUREL AVE",
            "city": "PLENTYWOOD",
            "state": "MT",
            "postal_code": "592541526",
            "telephone_number": "406-765-3700",
            "fax_number": "406-765-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHERIDAN MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-15",
        "last_updated": "2010-11-05",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "406-765-3700",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plentywood, MT

Sources for this page

Verify at the official NPI Registry.