Healthcare Provider Details

I. General information

NPI: 1124109558
Provider Name (Legal Business Name): SHELBY COUNTY CHRIS A. MYRTUE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 MAIN STREET
ELK HORN IA
51531
US

IV. Provider business mailing address

1213 GARFIELD AVE
HARLAN IA
51537-2057
US

V. Phone/Fax

Practice location:
  • Phone: 712-764-4642
  • Fax: 712-764-4643
Mailing address:
  • Phone: 712-755-5161
  • Fax: 712-755-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK WOODRING
Title or Position: CEO
Credential:
Phone: 712-755-4316