Provider Demographics
NPI:1417342288
Name:SHELBY COUNTY CHRIS A MYRTUE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SHELBY COUNTY CHRIS A MYRTUE MEMORIAL HOSPITAL
Other - Org Name:MYRTUE MEDICAL CENTER-EARLING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACOBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-755-4315
Mailing Address - Street 1:1213 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-2057
Mailing Address - Country:US
Mailing Address - Phone:712-755-4315
Mailing Address - Fax:712-755-4412
Practice Address - Street 1:100 INDUSTRIAL DR
Practice Address - Street 2:STE 101
Practice Address - City:EARLING
Practice Address - State:IA
Practice Address - Zip Code:51530-5213
Practice Address - Country:US
Practice Address - Phone:712-747-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELBY COUNTY CHRIS A MYRTUE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health