Provider Demographics
NPI:1689759169
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 SHELBY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-755-4316
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:712-755-5161
Mailing Address - Fax:712-755-4312
Practice Address - Street 1:301 EAST STREET
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:IA
Practice Address - Zip Code:51570
Practice Address - Country:US
Practice Address - Phone:712-544-2511
Practice Address - Fax:712-544-2512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
5582420005Medicare Oscar/Certification