Provider Demographics
NPI:1487736963
Name:CHEYENNE COUNTY HOSPITAL ASSOCIATION INC
Entity type:Organization
Organization Name:CHEYENNE COUNTY HOSPITAL ASSOCIATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:UTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-254-5064
Mailing Address - Street 1:1000 POLE CREEK CROSSING
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-2900
Mailing Address - Country:US
Mailing Address - Phone:308-254-5064
Mailing Address - Fax:308-254-2300
Practice Address - Street 1:1000 POLE CREEK CROSSING
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-2900
Practice Address - Country:US
Practice Address - Phone:308-254-5825
Practice Address - Fax:308-254-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 363A00000X
NE150001275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No275N00000XHospital UnitsMedicare Defined Swing Bed UnitGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00133OtherPROVIDER # FOR BLUE CROSS
NE=========00Medicaid
NE281357Medicare Oscar/Certification
NE085173Medicare PIN
NE28Z357Medicare Oscar/Certification