Provider Demographics
NPI:1679335202
Name:WYANDOT MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:WYANDOT MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position: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:CAREY PHARMACY
Mailing Address - Street 2:235 E NORTH ST
Mailing Address - City:CAREY
Mailing Address - State:OH
Mailing Address - Zip Code:43316-1068
Mailing Address - Country:US
Mailing Address - Phone:419-396-9203
Mailing Address - Fax:419-396-9233
Practice Address - Street 1:235 E NORTH ST
Practice Address - Street 2:
Practice Address - City:CAREY
Practice Address - State:OH
Practice Address - Zip Code:43316-1068
Practice Address - Country:US
Practice Address - Phone:419-396-9203
Practice Address - Fax:419-396-9233
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYANDOT MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-29
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy