Healthcare Provider Details

I. General information

NPI: 1083336952
Provider Name (Legal Business Name): BUENA VISTA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 RICHLAND DR
STORM LAKE IA
50588-3503
US

IV. Provider business mailing address

PO BOX 663
STORM LAKE IA
50588-0663
US

V. Phone/Fax

Practice location:
  • Phone: 712-749-2548
  • Fax: 712-749-2549
Mailing address:
  • Phone: 712-749-2548
  • Fax: 712-749-2549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE SATHER
Title or Position: ADMINISTRATOR
Credential: RN-BSN
Phone: 712-749-2548