Provider Demographics
NPI:1912740085
Name:WYANDOT MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:WYANDOT MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:TY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-294-4991
Mailing Address - Street 1:15 N PERRY ST # P98
Mailing Address - Street 2:
Mailing Address - City:NEW RIEGEL
Mailing Address - State:OH
Mailing Address - Zip Code:44853-9777
Mailing Address - Country:US
Mailing Address - Phone:567-281-1024
Mailing Address - Fax:567-281-1464
Practice Address - Street 1:15 N PERRY ST # P98
Practice Address - Street 2:
Practice Address - City:NEW RIEGEL
Practice Address - State:OH
Practice Address - Zip Code:44853-9777
Practice Address - Country:US
Practice Address - Phone:567-281-1024
Practice Address - Fax:567-281-1464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYANDOT MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health