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General NPI Number Information
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NPI Number | 1184603201
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Entity Type | Organization
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Legal Business Name | BUENA VISTA ANESTHESIA ASSOCIATES PLC
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 07/31/2015
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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
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Country | US
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Telephone | 573-686-5550
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Fax | 573-686-2139
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Provider Business Mailing Address
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Address Line | 209 S MAIN ST
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-5831
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Country | US
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Telephone | 573-686-5550
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Fax | 573-686-5550
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Authorized Official
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Title or Position | OPERATING MANAGER
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Name | MS. STEPHANIE MAXINE KRAUTH
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Credential | CRNA
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Telephone | 573-686-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 100514
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 148752
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | D040615
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License Number State | IA
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