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General NPI Number Information
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NPI Number | 1164593109
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Entity Type | Organization
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Legal Business Name | BUENA VISTA REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 1525 W 5TH ST
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City | STORM LAKE
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State | IA
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Zip | 50588-3027
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Country | US
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Telephone | 712-732-4030
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Fax | 712-213-1233
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Provider Business Mailing Address
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Address Line | 1525 W 5TH ST PO BOX 309
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City | STORM LAKE
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State | IA
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Zip | 50588-3027
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Country | US
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Telephone | 712-732-4030
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Fax | 712-213-1233
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Authorized Official
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Title or Position | CFO
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Name | MRS. KRISTA L KETCHAM
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Credential |
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Telephone | 712-213-8603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 166H
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License Number State | IA
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