Provider Demographics
NPI:1891733200
Name:P B R INC
Entity Type:Organization
Organization Name:P B R INC
Other - Org Name:MED-EQUIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TSCHOPP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:712-728-2165
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:HARTLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51346-0028
Mailing Address - Country:US
Mailing Address - Phone:712-728-2165
Mailing Address - Fax:712-728-2805
Practice Address - Street 1:1310 18TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1150
Practice Address - Country:US
Practice Address - Phone:712-336-1052
Practice Address - Fax:712-336-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
0207810004Medicare NSC