Healthcare Provider Details

I. General information

NPI: 1770683906
Provider Name (Legal Business Name): H.B. MAGRUDER MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 FULTON ST
PORT CLINTON OH
43452-2001
US

IV. Provider business mailing address

615 FULTON ST
PORT CLINTON OH
43452-2001
US

V. Phone/Fax

Practice location:
  • Phone: 419-734-3131
  • Fax:
Mailing address:
  • Phone: 419-734-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1252
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number StateOH

VIII. Authorized Official

Name: NICK MARSICO
Title or Position: PRESIDENT CEO
Credential:
Phone: 419-734-3131