Healthcare Provider Details

I. General information

NPI: 1629028600
Provider Name (Legal Business Name): FIRELANDS REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 HAYES AVE
SANDUSKY OH
44870-4793
US

IV. Provider business mailing address

1925 HAYES AVE
SANDUSKY OH
44870-4793
US

V. Phone/Fax

Practice location:
  • Phone: 419-557-5177
  • Fax: 419-557-5169
Mailing address:
  • Phone: 419-557-5177
  • Fax: 419-557-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. ROBERT MOORE
Title or Position: EXECUTIVE VICE PRESIDENT LEGAL
Credential:
Phone: 419-557-7400