Healthcare Provider Details

I. General information

NPI: 1275033011
Provider Name (Legal Business Name): WYANDOT MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 08/17/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W SAFFEL AVE
SYCAMORE OH
44882-9763
US

IV. Provider business mailing address

885 N SANDUSKY AVE
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 TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TY R SHAULL
Title or Position: PRESIDENT & CEO
Credential:
Phone: 419-294-4991