Healthcare Provider Details

I. General information

NPI: 1952774689
Provider Name (Legal Business Name): WYANDOT MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 W CHURCH ST
UPPER SANDUSKY OH
43351-1038
US

IV. Provider business mailing address

885 N SANDUSKY AVENUE
UPPER SANDUSKY OH
43351-1098
US

V. Phone/Fax

Practice location:
  • Phone: 419-294-4051
  • Fax: 419-294-0467
Mailing address:
  • Phone: 419-294-4991
  • Fax: 419-294-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number1296
License Number StateOH

VIII. Authorized Official

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