Provider Demographics
NPI:1821154220
Name:BUENA VISTA REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:BUENA VISTA REGIONAL MEDICAL CENTER
Other - Org Name:BVRMC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROB
Authorized Official - Last Name:COLERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-213-8600
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-0309
Mailing Address - Country:US
Mailing Address - Phone:712-732-4030
Mailing Address - Fax:712-213-1233
Practice Address - Street 1:620 NORTHWESTERN DR
Practice Address - Street 2:POD 2
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-2935
Practice Address - Country:US
Practice Address - Phone:712-213-8065
Practice Address - Fax:712-213-1233
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUENA VISTA REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-29
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IA1056333600000X, 3336C0002X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1166108Medicaid
IA1166108Medicaid