1467518860 NPI number — BUENA VISTA REGIONAL MEDICAL CENTER

Table of content: (NPI 1467518860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467518860 NPI number — BUENA VISTA REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUENA VISTA REGIONAL MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467518860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1525 W 5TH ST
Provider Second Line Business Mailing Address:
PO BOX 309
Provider Business Mailing Address City Name:
STORM LAKE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50588-3027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-732-4030
Provider Business Mailing Address Fax Number:
712-213-1233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1525 W 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STORM LAKE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50588-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-732-4030
Provider Business Practice Location Address Fax Number:
712-213-1233
Provider Enumeration Date:
12/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUDSPETH
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
712-213-8600

Provider Taxonomy Codes

  • Taxonomy code: 146D00000X , with the licence number:  110166H , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0671800 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".