Provider Demographics
NPI:1497750608
Name:MCKENZIE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MCKENZIE MEMORIAL HOSPITAL
Other - Org Name:MCKENZIE HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. FINANCE
Authorized Official - Prefix:MRS
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:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1009
Mailing Address - Country:US
Mailing Address - Phone:810-648-6162
Mailing Address - Fax:810-648-5058
Practice Address - Street 1:120 N DELAWARE ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1009
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:2005-06-15
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1060000096207P00000X
MIMI06100275N00000X
MI760030282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No275N00000XHospital UnitsMedicare Defined Swing Bed UnitGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI405171190Medicaid
MI301555717Medicaid
MI301555717Medicaid
MI231314Medicare Oscar/Certification