MEDICARE: MCKENZIE MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	275N00000X	Medicare Defined Swing Bed Hospital Unit	MI06100	MI
2	207P00000X	Emergency Medicine Physician	1060000096	MI
3	282NC0060X	Critical Access Hospital	760030	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497750608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCKENZIE MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	120 N DELAWARE ST
Second Line	:
City	:	SANDUSKY
State	:	MI
Zip	:	48471-1009
Country	:	US
Telephone Number	:	810-648-6162
Fax Number	:	810-648-5058

Provider Business Practice Location Address
First Line	:	120 N DELAWARE ST
Second Line	:
City	:	SANDUSKY
State	:	MI
Zip	:	48471-1009
Country	:	US
Telephone Number	:	810-648-6162
Fax Number	:	810-648-5058

Authorized Official
Title or Position	:	V.P. FINANCE
Name	:	MRS. AMY RUEDISUELI
Credential	:
Telephone Number	:	810-648-6162

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	10/21/2025

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Directions to “MCKENZIE MEMORIAL HOSPITAL ” Practice Location

Language	Start Address	Practice Location

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