Provider Demographics
NPI:1770683906
Name:H.B. MAGRUDER MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:H.B. MAGRUDER MEMORIAL HOSPITAL
Other - Org Name:MAGRUDER HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-734-3131
Mailing Address - Street 1:615 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-2001
Mailing Address - Country:US
Mailing Address - Phone:419-734-3131
Mailing Address - Fax:
Practice Address - Street 1:615 FULTON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2001
Practice Address - Country:US
Practice Address - Phone:419-734-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH275N00000X
OH1252314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000487253OtherANTHEM SWING
OH000000487253OtherANTHEM SWING
OH36Z314Medicare Oscar/Certification