Provider Demographics
NPI:1033271135
Name:MCKENZIE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MCKENZIE MEMORIAL HOSPITAL
Other - Org Name:MCKENZIE RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEDISUELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-648-6162
Mailing Address - Street 1:120 N DELAWARE ST
Mailing Address - Street 2:AUSTIN STREET HEALTH CLINIC
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1009
Mailing Address - Country:US
Mailing Address - Phone:810-648-3770
Mailing Address - Fax:810-648-5058
Practice Address - Street 1:75 DAWSON ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-3323
Practice Address - Country:US
Practice Address - Phone:810-648-6162
Practice Address - Fax:810-648-5058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI238537Medicare UPIN