MEDICARE: WYANDOT MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1912740085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYANDOT MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	15 N PERRY ST # P98
Second Line	:
City	:	NEW RIEGEL
State	:	OH
Zip	:	44853-9777
Country	:	US
Telephone Number	:	567-281-1024
Fax Number	:	567-281-1464

Provider Business Practice Location Address
First Line	:	15 N PERRY ST # P98
Second Line	:
City	:	NEW RIEGEL
State	:	OH
Zip	:	44853-9777
Country	:	US
Telephone Number	:	567-281-1024
Fax Number	:	567-281-1464

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	TY R SHAULL
Credential	:
Telephone Number	:	419-294-4991

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	06/17/2024

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