Healthcare Provider Details

I. General information

NPI: 1497750608
Provider Name (Legal Business Name): MCKENZIE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N DELAWARE ST
SANDUSKY MI
48471-1009
US

IV. Provider business mailing address

120 N DELAWARE ST
SANDUSKY MI
48471-1009
US

V. Phone/Fax

Practice location:
  • Phone: 810-648-6162
  • Fax: 810-648-5058
Mailing address:
  • Phone: 810-648-6162
  • Fax: 810-648-5058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1060000096
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberMI06100
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number760030
License Number StateMI

VIII. Authorized Official

Name: MRS. AMY RUEDISUELI
Title or Position: V.P. FINANCE
Credential:
Phone: 810-648-6162