Healthcare Provider Details

I. General information

NPI: 1194938068
Provider Name (Legal Business Name): MYRTUE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 GARFIELD AVE
HARLAN IA
51537-2057
US

IV. Provider business mailing address

11606 NICHOLAS ST SUITE 200
OMAHA NE
68154-4478
US

V. Phone/Fax

Practice location:
  • Phone: 712-755-5161
  • Fax:
Mailing address:
  • Phone: 402-493-2020
  • Fax: 402-493-8341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. SAO JANG LIU
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 402-493-2020