Healthcare Provider Details

I. General information

NPI: 1053827303
Provider Name (Legal Business Name): WYANDOT MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N PENNINGTON ST
SYCAMORE OH
44882-9408
US

IV. Provider business mailing address

885 N SANDUSKY AVENUE
UPPER SANDUSKY OH
43351-1098
US

V. Phone/Fax

Practice location:
  • Phone: 419-927-6552
  • Fax: 419-927-6500
Mailing address:
  • Phone: 419-294-4991
  • Fax: 419-209-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY ANNE SCHWENNING
Title or Position: MEDICAL STAFF COORDINATOR
Credential:
Phone: 419-294-4991