Provider Demographics
NPI:1639427560
Name:BPRC LLC
Entity Type:Organization
Organization Name:BPRC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEURET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-600-1137
Mailing Address - Street 1:PO BOX 790129
Mailing Address - Street 2:DEPT 10006
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0129
Mailing Address - Country:US
Mailing Address - Phone:402-817-1397
Mailing Address - Fax:402-939-0410
Practice Address - Street 1:1610 S 70TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1565
Practice Address - Country:US
Practice Address - Phone:402-817-1397
Practice Address - Fax:402-939-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA2246Medicare PIN
NE6724960001Medicare NSC