Basic Information
| Provider Information | |||||||||
| NPI: | 1932747946 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCKENZIE MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 N DELAWARE STREET | ||||||||
| Address2: | |||||||||
| City: | SANDUSKY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106486152 | ||||||||
| FaxNumber: | 8106483352 | ||||||||
| Practice Location | |||||||||
| Address1: | 170 W ARGYLE STREET | ||||||||
| Address2: | |||||||||
| City: | SANDUSKY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106483229 | ||||||||
| FaxNumber: | 8106485404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2019 | ||||||||
| LastUpdateDate: | 12/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | RUEDISUELI | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | I. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8106486162 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MCKENZIE MEMORIAL HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 12/20/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.