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NPI Code Detail

MEDICARE: SHELBY COUNTY CHRIS A. MYRTUE MEMORIAL HOSPITAL

MEDICARE: SHELBY COUNTY CHRIS A. MYRTUE MEMORIAL HOSPITAL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist
21041C0700XClinical Social Worker
3207R00000XInternal Medicine Physician
4207RX0202XMedical Oncology Physician
5208000000XPediatrics Physician
6208600000XSurgery Physician
7213ES0103XFoot & Ankle Surgery Podiatrist
8282NC0060XCritical Access Hospital
9363A00000XPhysician Assistant
10363L00000XNurse Practitioner
11363LP0808XPsychiatric/Mental Health Nurse Practitioner
12367500000XCertified Registered Nurse Anesthetist
13207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922184175
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHELBY COUNTY CHRIS A. MYRTUE MEMORIAL HOSPITAL
Provider Business Mailing Address
First Line : 1213 GARFIELD AVE
Second Line :
City : HARLAN
State : IA
Zip : 51537-2057
Country : US
Telephone Number : 712-755-5161
Fax Number : 712-755-4312
Provider Business Practice Location Address
First Line : 1213 GARFIELD AVE
Second Line :
City : HARLAN
State : IA
Zip : 51537-2057
Country : US
Telephone Number : 712-755-5161
Fax Number : 712-755-4312
Authorized Official
Title or Position : CEO
Name : MR. BARRY A. JACOBSEN
Credential :
Telephone Number : 712-755-4315
Provider Enumeration Date : 10/31/2006
Last Update Date : 07/26/2024

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