Basic Information
| Provider Information | |||||||||
| NPI: | 1033271135 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MCKENZIE MEMORIAL HOSPITAL | ||||||||
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| OtherOrganizationName: | MCKENZIE RURAL HEALTH CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 N DELAWARE ST | ||||||||
| Address2: | AUSTIN STREET HEALTH CLINIC | ||||||||
| City: | SANDUSKY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484711009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106483770 | ||||||||
| FaxNumber: | 8106485058 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 DAWSON ST | ||||||||
| Address2: | |||||||||
| City: | SANDUSKY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484713323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106486162 | ||||||||
| FaxNumber: | 8106485058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 05/02/2016 | ||||||||
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| AuthorizedOfficialLastName: | RUEDISUELI | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | V.P. FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 8106486162 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.