Organization
BUENA VISTA ANESTHESIA ASSOCIATES PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE MAXINE KRAUTH CRNA (OPERATING MANAGER)
(573) 686-5550
Entity
Organization
Contact information
Practice address
1525 W 5TH ST, STORM LAKE, IA 50588
(573) 686-5550
(573) 686-2139
Mailing address
209 S MAIN ST, POPLAR BLUFF, MO 63901-5831
(573) 686-5550
(573) 686-5550
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
100514
NE
367500000X
Certified Registered Nurse Anesthetist
148752
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
D040615
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0160879
—
IA
01
—
40130
BCBS
—
01
—
P00252415
TRAV RR
—
Enumeration date
01/17/2006
Last updated
07/31/2015
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