Healthcare Provider Details

I. General information

NPI: 1043269780
Provider Name (Legal Business Name): BUENA VISTA REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W MILWAUKEE AVE
STORM LAKE IA
50588-2904
US

IV. Provider business mailing address

PO BOX 309
STORM LAKE IA
50588-0309
US

V. Phone/Fax

Practice location:
  • Phone: 712-749-2741
  • Fax: 712-749-2750
Mailing address:
  • Phone: 712-732-4030
  • Fax: 712-213-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateIA

VIII. Authorized Official

Name: MRS. KRISTA L KETCHAM
Title or Position: CFO
Credential:
Phone: 712-213-1233