Provider Demographics
NPI:1518951870
Name:WYANDOT MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:WYANDOT MEMORIAL HOSPITAL
Other - Org Name:WYANDOT MEMORIAL HOME HEALTH AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:TY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-294-4991
Mailing Address - Street 1:105 HOUPT DR
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-9201
Mailing Address - Country:US
Mailing Address - Phone:419-294-3881
Mailing Address - Fax:419-294-6401
Practice Address - Street 1:105 HOUPT DR
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-9201
Practice Address - Country:US
Practice Address - Phone:419-294-3881
Practice Address - Fax:419-294-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0380250Medicaid
OH0380250Medicaid