Basic Information
| Provider Information | |||||||||
| NPI: | 1922079532 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | H.B. MAGRUDER MEMORIAL HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MAGRUDER HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 FULTON ST | ||||||||
| Address2: | |||||||||
| City: | PORT CLINTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434522001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197343131 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 615 FULTON ST | ||||||||
| Address2: | |||||||||
| City: | PORT CLINTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434522001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197343131 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2006 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MARSICO | ||||||||
| AuthorizedOfficialFirstName: | NICK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 4197343131 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 282NC0060X | 1252 | OH | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 000000064558 | 01 | OH | UNICARE | OTHER | 05029 | 01 | OH | PARAMOUNT INSURANCE | OTHER | 395857 | 01 | OH | BLACK LUNG | OTHER | 361314 | 01 | OH | HUMANA MEDICARE HMO | OTHER | 600827 | 01 | OH | BUCKEYE COMMUNITY | OTHER | 000000064558 | 01 | OH | ANTHEM | OTHER | 344442792 | 01 | OH | TRICARE | OTHER | 5430662 | 05 | OH | MEDICAID | 107536 | 01 | OH | KAISER | OTHER | 0062084 | 01 | OH | AETNA | OTHER |