Healthcare Provider Details

I. General information

NPI: 1316054034
Provider Name (Legal Business Name): SHELBY COUNTY CHRIS A MYRTUE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 EAST STREET
SHELBY IA
51570-3319
US

IV. Provider business mailing address

1213 GARFIELD AVE
HARLAN IA
51537-2057
US

V. Phone/Fax

Practice location:
  • Phone: 712-544-2511
  • Fax: 712-544-2512
Mailing address:
  • Phone: 712-755-5161
  • Fax: 712-755-4412

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. BARRY A. JACOBSEN
Title or Position: CEO
Credential:
Phone: 712-755-4315