Organization
BUENA VISTA REGIONAL MEDICAL CENTER
Active
Other names
Buena Vista Regional Medical Center Dept of EKG
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA L KETCHAM (CFO)
(712) 213-8603
Entity
Organization
Contact information
Practice address
1525 W 5TH ST, STORM LAKE, IA 50588-3027
(712) 732-4030
(712) 213-1233
Mailing address
1525 W 5TH ST, PO BOX 309, STORM LAKE, IA 50588-3027
(712) 732-4030
(712) 213-1233
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
166H
IA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
166H
IN
208600000X
Surgery Physician
110166H
IA
208800000X
Urology Physician
—
—
208M00000X
Hospitalist Physician
—
—
213E00000X
Podiatrist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
110166H
IA
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0078782
—
IA
01
—
30564
WELLMARK GROUP NUMBER
IA
Enumeration date
11/13/2006
Last updated
12/10/2024
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