NPIMap

Organization Active NPI

Wyandot Memorial Hospital

Doing business as Wyandot Medical Providers at Forest

  • Rural Health Clinic/Center
  • Forest, OH
National Provider Identifier
1861908071
Registry record updated Sep 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WYANDOT MEMORIAL HOSPITAL
Doing business as
Wyandot Medical Providers at Forest
Practice address
112 E Lima St
Forest, OH 45843-1116
Phone
(419) 273-5104
Fax
(419) 273-5106
NPI assigned
Dec 26, 2017
Reactivated
Sep 23, 2022
Last updated
Sep 23, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
WYANDOT MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ty R Shaull
Title
President & Ceo
Phone
(419) 294-4991

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

112 E Lima St
Forest, OH 45843-1116

Mailing address

885 N Sandusky Ave
Upper Sandusky, OH 43351-1098
Phone (419) 294-4991

Other identifiers 1

IdentifierTypeStateIssuer
0394927MedicaidOH

Other names 1

  • Wyandot Medical Providers at Forest Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230915001914 OH Part A Provider - Rural Health Clinic 1557340189 Practice locations: Forest, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861908071. Details of each certification follow.

Rural health clinic certification: CCN 363441

Legal name
WYANDOT MEMORIAL HOSPITAL
Doing business as
WYANDOT MEDICAL PROVIDERS AT FOREST
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 14, 2023
Last certification
Aug 14, 2023
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Sep 20, 2022 in OH
Enrollment address
112 E Lima St
Forest, OH 45843-1116
Related CCNs
361329

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2258522Wyandot Medical Providers at Forest112 East Lima Street, Forest, OH 45843Certificate of waiverApr 21, 2028

National Provider Directory

National Provider Directory
Part of
Wyandot Memorial Hospti

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rob McClure Individual Corporate DirectorDirector Aug 1, 2018
Jeff Bowen Individual Corporate DirectorDirector Jan 1, 2023
Roberta S Sigler Individual Corporate DirectorDirector Aug 1, 2017
Kendra Noyes Individual Corporate OfficerPresident and Ceo Jul 1, 2025
W-2 Managing EmployeePresident and Ceo Jun 26, 2000
David Courtad Individual Corporate DirectorBoard Member Jan 1, 2025
Mary Anne Schwenning Individual W-2 Managing EmployeeCredentialing Sep 30, 2005
Krista Kenner Individual W-2 Managing EmployeeCredentialing/Enrollment Specialist Apr 7, 2014
Kyle Bowman Individual Corporate DirectorChairman Oct 1, 2004
Beth Smith Individual Corporate DirectorDirector Jan 1, 2009

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wyandot Memorial HospitalUpper Sandusky, OH, CCN 361329 Hospital Operational/Managerial Control Jul 1, 1966

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1514246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663891200000",
    "number": "1861908071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 N SANDUSKY AVE",
            "city": "UPPER SANDUSKY",
            "state": "OH",
            "postal_code": "433511098",
            "telephone_number": "419-294-4991",
            "fax_number": "419-209-0278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 E LIMA ST",
            "city": "FOREST",
            "state": "OH",
            "postal_code": "458431116",
            "telephone_number": "419-273-5104",
            "fax_number": "419-273-5106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYANDOT MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WYANDOT MEMORIAL HOSPITAL",
        "enumeration_date": "2017-12-26",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "deactivation_date": "2022-08-11",
        "reactivation_date": "2022-09-23",
        "status": "A",
        "authorized_official_last_name": "SHAULL",
        "authorized_official_first_name": "TY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "419-294-4991"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0394927",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wyandot Medical Providers at Forest",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forest, OH

Sources for this page

Verify at the official NPI Registry.