Healthcare Provider Details

I. General information

NPI: 1821154220
Provider Name (Legal Business Name): BUENA VISTA REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NORTHWESTERN DR POD 2
STORM LAKE IA
50588-2935
US

IV. Provider business mailing address

PO BOX 309
STORM LAKE IA
50588-0309
US

V. Phone/Fax

Practice location:
  • Phone: 712-213-8065
  • Fax: 712-213-1233
Mailing address:
  • Phone: 712-732-4030
  • Fax: 712-213-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1056
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number1056
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1056
License Number StateIA

VIII. Authorized Official

Name: MR. STEVEN ROB COLERICK
Title or Position: CEO
Credential:
Phone: 712-213-8600