Provider Demographics
NPI:1053827303
Name:WYANDOT MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:WYANDOT MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-294-4991
Mailing Address - Street 1:885 N SANDUSKY AVENUE
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1098
Mailing Address - Country:US
Mailing Address - Phone:419-294-4991
Mailing Address - Fax:419-209-0278
Practice Address - Street 1:103 N PENNINGTON ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:OH
Practice Address - Zip Code:44882-9408
Practice Address - Country:US
Practice Address - Phone:419-927-6552
Practice Address - Fax:419-927-6500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYANDOT MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9687512Medicaid